Beyond Self-Consistency: Ensemble Reasoning Boosts Consistency and Accuracy of LLMs in Cancer Staging

Advances in large language models (LLMs) have encouraged their adoption in the healthcare domain where vital clinical information is often contained in unstructured notes. Cancer staging status is available in clinical reports, but it requires natural language processing to extract the status from the unstructured text. With the advance in clinical-oriented LLMs, it is promising to extract such status without extensive efforts in training the algorithms. Prompting approaches of the pre-trained LLMs that elicit a model's reasoning process, such as chain-of-thought, may help to improve the trustworthiness of the generated responses. Using self-consistency further improves model performance, but often results in inconsistent generations across the multiple reasoning paths. In this study, we propose an ensemble reasoning approach with the aim of improving the consistency of the model generations. Using an open access clinical large language model to determine the pathologic cancer stage from real-world pathology reports, we show that the ensemble reasoning approach is able to improve both the consistency and performance of the LLM in determining cancer stage, thereby demonstrating the potential to use these models in clinical or other domains where reliability and trustworthiness are critical.

Classifying Cancer Stage with Open-Source Clinical Large Language Models

Cancer stage classification is important for making treatment and care management plans for oncology patients. Information on staging is often included in unstructured form in clinical, pathology, radiology and other free-text reports in the electronic health record system, requiring extensive work to parse and obtain. To facilitate the extraction of this information, previous NLP approaches rely on labeled training datasets, which are labor-intensive to prepare. In this study, we demonstrate that without any labeled training data, open-source clinical large language models (LLMs) can extract pathologic tumor-node-metastasis (pTNM) staging information from real-world pathology reports. Our experiments compare LLMs and a BERT-based model fine-tuned using the labeled data. Our findings suggest that while LLMs still exhibit subpar performance in Tumor (T) classification, with the appropriate adoption of prompting strategies, they can achieve comparable performance on Metastasis (M) classification and improved performance on Node (N) classification.