arXiv:2608.03079cs.CVcs.AI2026-08

专为乳腺穿刺活检设计的病理模型,提升诊断准确率并减少报告错误。

CorePath: A Breast-Specialized Pathology Foundation Model for Core Needle Biopsy Diagnosis and Risk-Controlled Report Generation

论文配图:CorePath: A Breast-Specialized Pathology Foundation Model for Core Needle Biopsy Diagnosis and Risk-Controlled Report Generation
图 1 · 摘自论文原文
  • 基于7901对病理图与报告微调,专注乳腺穿刺诊断。
  • 在多个数据集上亚型分类AUC达0.9526-0.9735,优于现有模型。
  • 引入风险控制机制,报告幻觉率从30.1%降至2.8%,适合临床部署。

乳腺核心针穿刺活检(CNB)是乳腺癌诊断的关键,但受限于组织取样少、病灶异质性及形态学重叠,亚型区分困难。我们开发了CorePath,一个基于PRISM、在两个中心共7901对CNB全切片图像与诊断报告上微调的乳腺专用多模态病理基础模型。在六个独立CNB队列和两个公开乳腺病理基准测试中,无需任务特定微调,CorePath持续优于PRISM,在癌症检测、浸润评估和组织学分型上表现更佳。其五类CNB组织学亚型分类加权AUC为0.9526–0.9735。在公开基准上,优于主流病理基础模型,分别达到BCNB浸润性癌分型加权AUC 0.7780,BRACS病变分层0.8178,细粒度分类0.8252。在报告生成方面,核心路径将非乳腺幻觉率从30.1%降至2.8%,体现更强领域一致性。CorePath-CRG进一步结合置信度校准与学习后测试风险控制,实现选择性报告发布、亚型级回退与延迟决策。该模型在释放输出中实现零非乳腺幻觉,并在病理医生验证的LLM评估分数和定量报告生成指标上表现最佳,证明领域专化基础模型与统计风险控制可显著提升乳腺穿刺诊断准确性与报告可靠性。

原文摘要 · Abstract (English)

Breast core needle biopsy (CNB) is central to breast cancer diagnosis yet remains challenging because limited tissue sampling, lesion heterogeneity, and subtle morphologic overlap can obscure subtype distinctions. We developed CorePath, a breast-specialized multimodal pathology foundation model fine-tuned from PRISM using 7901 paired CNB whole-slide images and diagnostic reports from two centers. Evaluated across six CNB cohorts and two public breast pathology benchmarks without task-specific retraining, CorePath consistently outperformed PRISM across cancer detection, invasion assessment, and histological subtyping. It achieved weighted area under the receiver operating characteristic curves (AUCs) of 0.9526-0.9735 for five-class CNB histological subtyping across private centers. On public benchmarks, CorePath outperformed leading pathology foundation models, achieving the highest weighted AUCs of 0.7780 for BCNB invasive carcinoma subtyping, 0.8178 for BRACS lesion stratification, and 0.8252 for BRACS fine-grained classification. In report generation, CorePath reduced the overall non-breast hallucinations from 30.1% to 2.8%, demonstrating improved domain fidelity after breast-specific adaptation. CorePath-CRG further combined conformal subtype-confidence gating with Learn-Then-Test risk control to enable selective report release, subtype-level fallback, and deferral. CorePath-CRG achieved zero non-breast hallucinations among released outputs and showed the strongest overall performance in pathologist-validated LLM-based Evaluation Scores and quantitative report-generation metrics across most centers. These results demonstrate that domain-specialized foundation models with statistical risk control offer a promising approach for accurate breast CNB diagnosis and reliable report generation.

病理模型乳腺癌报告生成风险控制

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