Automated Clinical Data Extraction with Knowledge Conditioned LLMs

The extraction of lung lesion information from clinical and medical imaging reports is crucial for research on and clinical care of lung-related diseases. Large language models (LLMs) can be effective at interpreting unstructured text in reports, but they often hallucinate due to a lack of domain-specific knowledge, leading to reduced accuracy and posing challenges for use in clinical settings. To address this, we propose a novel framework that aligns generated internal knowledge with external knowledge through in-context learning (ICL). Our framework employs a retriever to identify relevant units of internal or external knowledge and a grader to evaluate the truthfulness and helpfulness of the retrieved internal-knowledge rules, to align and update the knowledge bases. Our knowledge-conditioned approach also improves the accuracy and reliability of LLM outputs by addressing the extraction task in two stages: (i) lung lesion finding detection and primary structured field parsing, followed by (ii) further parsing of lesion description text into additional structured fields. Experiments with expert-curated test datasets demonstrate that this ICL approach can increase the F1 score for key fields (lesion size, margin and solidity) by an average of 12.9% over existing ICL methods.

Improving Precancerous Case Characterization via Transformer-based Ensemble Learning

The application of natural language processing (NLP) to cancer pathology reports has been focused on detecting cancer cases, largely ignoring precancerous cases. Improving the characterization of precancerous adenomas assists in developing diagnostic tests for early cancer detection and prevention, especially for colorectal cancer (CRC). Here we developed transformer-based deep neural network NLP models to perform the CRC phenotyping, with the goal of extracting precancerous lesion attributes and distinguishing cancer and precancerous cases. We achieved 0.914 macro-F1 scores for classifying patients into negative, non-advanced adenoma, advanced adenoma and CRC. We further improved the performance to 0.923 using an ensemble of classifiers for cancer status classification and lesion size named entity recognition (NER). Our results demonstrated the potential of using NLP to leverage real-world health record data to facilitate the development of diagnostic tests for early cancer prevention.