用大模型+专家系统结合,让癌症诊断建议更准更可靠。
Expertise Is What We Want
- 用大语言模型处理病历文本,专家系统保证决策逻辑可解释。
- 在真实数据中准确识别95%以上患者的正确检查流程。
- 适合需要高可靠性医疗辅助的临床医生和系统开发者。
临床决策依赖专家推理,由标准化、基于证据的指南指导。然而,将这些指南转化为自动化临床决策支持系统,容易导致不准确并丢失细节。我们提出一种名为大型语言专家(LLE)的应用架构,融合大语言模型(LLMs)的灵活性与强大能力,以及专家系统的可解释性、可说明性和可靠性。LLMs有助于解决专家系统在知识整合与数据标准化方面的挑战;而专家系统式的结构则缓解了大模型的幻觉、更新成本低且易于测试的问题。为展示LLE系统的潜力,我们构建了一个协助新诊癌症患者进行评估的LLE系统。及时启动癌症治疗对改善患者预后至关重要。然而,诊断建议日益复杂,使初级保健医生难以确保患者在首次肿瘤科就诊前完成必要检查。此类任务需分析非结构化健康记录并应用精细的临床决策逻辑。本研究描述了该LLE系统的设计与评估,其展现出临床级高精度(>95%),有效解决了某大型学术中心乳腺癌与结肠癌患者真实数据中的关键检查缺口。
原文摘要 · Abstract (English)
Clinical decision-making depends on expert reasoning, which is guided by standardized, evidence-based guidelines. However, translating these guidelines into automated clinical decision support systems risks inaccuracy and importantly, loss of nuance. We share an application architecture, the Large Language Expert (LLE), that combines the flexibility and power of Large Language Models (LLMs) with the interpretability, explainability, and reliability of Expert Systems. LLMs help address key challenges of Expert Systems, such as integrating and codifying knowledge, and data normalization. Conversely, an Expert System-like approach helps overcome challenges with LLMs, including hallucinations, atomic and inexpensive updates, and testability. To highlight the power of the Large Language Expert (LLE) system, we built an LLE to assist with the workup of patients newly diagnosed with cancer. Timely initiation of cancer treatment is critical for optimal patient outcomes. However, increasing complexity in diagnostic recommendations has made it difficult for primary care physicians to ensure their patients have completed the necessary workup before their first visit with an oncologist. As with many real-world clinical tasks, these workups require the analysis of unstructured health records and the application of nuanced clinical decision logic. In this study, we describe the design & evaluation of an LLE system built to rapidly identify and suggest the correct diagnostic workup. The system demonstrated a high degree of clinical-level accuracy (>95%) and effectively addressed gaps identified in real-world data from breast and colon cancer patients at a large academic center.
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