The Augmented Cytopathologist: A Conceptual Exploratory Narrative Review on Immersive and Vision–Language Models Tools in Digital Pathology

Emerging digital technologies, including immersive environments (VR/AR/XR) and Vision– Language Models (VLMs), have the potential to reshape digital pathology and medical imaging. While immersive tools can enhance spatial visualization and procedural training, VLM-based copilots offer cognitive and workflow support. Their combined impact on cytopathology remains largely conceptual and preclinical. This Conceptual Exploratory Narrative Review (CENR) examines how immersive technologies and VLM-based copilots may jointly influence cytopathologists’ professional workflow, training, and diagnostic processes, introducing the notion of the “augmented cytopathologist.” A structured ex- ploratory approach integrated peer-reviewed literature, position papers, preprints, gray lit- erature (technical reports, white papers, conference abstracts, blogs), and cross-disciplinary perspectives. Database searches (PubMed, Web of Science, Scopus) confirmed a limited number of studies addressing immersive or AI-assisted cytopathology imaging. Thematic analysis focused on four conceptual dimensions: (1) technological capabilities and maturity; (2) workflow and educational applications; (3) professional implications and cytopatholo- gist role; and (4) responsible use of LLMs and VLMs as supportive tools. This approach emphasizes interpretation of emerging trends over aggregation of empirical data, enabling conceptual synthesis of early-stage implementations and perspectives in the field. Immer- sive technologies facilitate three-dimensional visualization, procedural skill development, and collaborative engagement, whereas VLMs support report generation, literature re- trieval, and decision guidance. Together, they offer a synergistic model for perceptual and cognitive augmentation. Key challenges include technical maturity, interoperability, workflow integration, regulatory compliance, and ethical oversight. Figures illustrate rep- resentative examples of (1) remote collaborative immersive evaluation and (2) integration of immersive visualization with VLM-based copilots, highlighting potential applications in training and workflow support. The CENR underscores the potential of combining immer- sive tools and AI copilots to support cytopathology, particularly for education, workflow efficiency, and cognitive augmentation. Adoption should be incremental and carefully gov- erned, emphasizing augmentative rather than transformative use. Future research should focus on clinical validation, scalable integration, and regulatory and ethical frameworks to realize the concept of the augmented cytopathologist in practice.