PathGLS: Evaluating Pathology Vision-Language Models without Ground Truth through Multi-Dimensional Consistency

Abstract: Vision-LLMs (VLMs) offer significant potential in computational pathology by enabling interpretable image analysis, automated reporting, and scalable decision support. However, their widespread clinical adoption remains limited due to the absence of reliable, automated evaluation metrics capable of identifying subtle failures such as hallucinations. To address this gap, we propose PathGLS, a novel reference-free evaluation framework that assesses pathology VLMs across three dimensions: Grounding (fine-grained visual-text alignment), Logic (entailment graph consistency using Natural Language Inference), and Stability (output variance under adversarial visual-semantic perturbations). PathGLS supports both patch-level and whole-slide image (WSI)-level analysis, yielding a comprehensive trust score. Experiments on Quilt-1M, TCGA, REG2025, PathMMU and TCGA-Sarcoma datasets demonstrate the superiority of PathGLS. Specifically, on the Quilt-1M dataset, PathGLS reveals a steep sensitivity drop of 40.2% for hallucinated reports compared to only 2.1% for BERTScore. Moreover, validation against expert-defined clinical error hierarchies reveals that PathGLS achieves a strong Spearman's rank correlation of $ρ=0.71$ ($p < 0.0001$), significantly outperforming LLM-based approaches (Gemini 3.0 Pro: $ρ=0.39$, $p < 0.0001$). These results establish PathGLS as a robust reference-free metric. By directly quantifying hallucination rates and domain shift robustness, it serves as a reliable criterion for benchmarking VLMs on private clinical datasets and informing safe deployment. Code can be found at: https://github.com/My13ad/PathGLS