Foundation Models in Computational Pathology: A Review of Challenges, Opportunities, and Impact

From self-supervised, vision-only models to contrastive visual-language frameworks, computational pathology has rapidly evolved in recent years. Generative AI "co-pilots" now demonstrate the ability to mine subtle, sub-visual tissue cues across the cellular-to-pathology spectrum, generate comprehensive reports, and respond to complex user queries. The scale of data has surged dramatically, growing from tens to millions of multi-gigapixel tissue images, while the number of trainable parameters in these models has risen to several billion. The critical question remains: how will this new wave of generative and multi-purpose AI transform clinical diagnostics? In this article, we explore the true potential of these innovations and their integration into clinical practice. We review the rapid progress of foundation models in pathology, clarify their applications and significance. More precisely, we examine the very definition of foundational models, identifying what makes them foundational, general, or multipurpose, and assess their impact on computational pathology. Additionally, we address the unique challenges associated with their development and evaluation. These models have demonstrated exceptional predictive and generative capabilities, but establishing global benchmarks is crucial to enhancing evaluation standards and fostering their widespread clinical adoption. In computational pathology, the broader impact of frontier AI ultimately depends on widespread adoption and societal acceptance. While direct public exposure is not strictly necessary, it remains a powerful tool for dispelling misconceptions, building trust, and securing regulatory support.