用少量专家标注数据,让模型从病历中精准识别罕见肺病及亚型。
A Weakly Supervised Transformer for Rare Disease Diagnosis and Subphenotyping from EHRs with Pulmonary Case Studies
- 基于弱监督的Transformer模型,融合结构化与非结构化病历数据
- 在波士顿儿童医院数据上,分类与亚型识别均优于现有方法
- 适合缺乏标注数据的罕见病研究,可加速诊断与发现
罕见病影响全球约3亿至4亿人,但因发病率低、医生认知不足,常被漏诊或误诊。计算表型分析提供可扩展的检测途径,但算法开发受限于高质量标注数据稀缺。专家标注数据准确但范围有限,而来自电子健康记录(EHR)的标签覆盖广但噪声多。为此,我们提出WEST(WEakly Supervised Transformer for rare disease phenotyping and subphenotyping from EHRs),一种结合常规EHR数据与少量专家验证病例/对照的框架。WEST采用弱监督Transformer模型,利用由结构化与非结构化EHR特征生成的迭代优化概率银标准标签进行训练,提升模型校准性。我们在波士顿儿童医院的两种罕见肺病数据上评估,结果表明WEST在表型分类、临床有意义亚型识别及疾病进展预测方面均优于现有方法。该方法减少对人工标注的依赖,实现数据高效表型分析,提升队列定义精度,支持更早更准诊断,并推动罕见病数据驱动研究。
原文摘要 · Abstract (English)
Rare diseases affect an estimated 300-400 million people worldwide, yet individual conditions remain underdiagnosed and poorly characterized due to their low prevalence and limited clinician familiarity. Computational phenotyping offers a scalable approach to improving rare disease detection, but algorithm development is hindered by the scarcity of high-quality labeled data for training. Expert-labeled datasets from chart reviews and registries are clinically accurate but limited in scope and availability, whereas labels derived from electronic health records (EHRs) provide broader coverage but are often noisy or incomplete. To address these challenges, we propose WEST (WEakly Supervised Transformer for rare disease phenotyping and subphenotyping from EHRs), a framework that combines routinely collected EHR data with a limited set of expert-validated cases and controls to enable large-scale phenotyping. At its core, WEST employs a weakly supervised transformer model trained on extensive probabilistic silver-standard labels - derived from both structured and unstructured EHR features - that are iteratively refined during training to improve model calibration. We evaluate WEST on two rare pulmonary diseases using EHR data from Boston Children's Hospital and show that it outperforms existing methods in phenotype classification, identification of clinically meaningful subphenotypes, and prediction of disease progression. By reducing reliance on manual annotation, WEST enables data-efficient rare disease phenotyping that improves cohort definition, supports earlier and more accurate diagnosis, and accelerates data-driven discovery for the rare disease community.
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