Case-Grounded Evidence Verification: A Framework for Constructing Evidence-Sensitive Supervision
Organizations: RWTH Aachen University, Aachen, Germany
Abstract
Evidence-grounded reasoning requires more than attaching retrieved text to a prediction: a model should make decisions that depend on whether the provided evidence supports the target claim. In practice, this often fails because supervision is weak, evidence is only loosely tied to the claim, and evaluation does not test evidence dependence directly. We introduce case-grounded evidence verification, a general framework in which a model receives a local case context, external evidence, and a structured claim, and must decide whether the evidence supports the claim for that case. Our key contribution is a supervision construction procedure that generates explicit support examples together with semantically controlled non-support examples, including counterfactual wrong-state and topic-related negatives, without manual evidence annotation. We instantiate the framework in radiology and train a standard verifier on the resulting support task. The learned verifier substantially outperforms both case-only and evidence-only baselines, remains strong under correct evidence, and collapses when evidence is removed or swapped, indicating genuine evidence dependence. This behavior transfers across unseen evidence articles and an external case distribution, though performance degrades under evidence-source shift and remains sensitive to backbone choice. Overall, the results suggest that a major bottleneck in evidence grounding is not only model capacity, but the lack of supervision that encodes the causal role of evidence.
Figures & tables
| System | AUROC | AUPRC | F1 | Bal. Acc. | Brier |
|---|---|---|---|---|---|
| S1: Case + Claim | 59.90 | 26.23 | 32.21 | 58.40 | 0.201 |
| S2: Evidence + Claim | 82.63 | 35.11 | 62.79 | 87.53 | 0.255 |
| S3: Case + Evidence + Claim | 97.43 | 87.78 | 78.72 | 92.03 | 0.060 |
| System / Condition | AUROC | AUPRC | F1 | Bal. Acc. | Brier |
|---|---|---|---|---|---|
| S1: Case + Claim | 52.85 | 29.16 | 28.92 | 53.59 | 0.266 |
| S2: Evidence + Claim | 79.81 | 42.46 | 66.45 | 83.16 | 0.297 |
| S3: Case + Evidence + Claim | 93.46 | 78.09 | 75.15 | 87.45 | 0.129 |
| Held-Out Articles | 88.37 | 61.23 | 72.13 | 86.47 | 0.193 |
| Swapped Evidence | 53.18 | 28.52 | 31.69 | 53.62 | 0.352 |
| Source-Matched Evidence | Held-Out Evidence | |||||
|---|---|---|---|---|---|---|
| Backbone | AUPRC | F1 | Brier | AUPRC | F1 | Brier |
| Flan-T5-large (751M) ( 8 ) | 84.76 | 75.33 | 0.071 | 74.04 | 77.19 | 0.108 |
| ModernBERT-large (395M) ( 61 ) | 87.78 | 78.72 | 0.060 | 74.18 | 77.94 | 0.075 |
| RoBERTa-large (355M) ( 37 ) | 78.18 | 63.50 | 0.084 | 64.98 | 77.61 | 0.116 |
| ELECTRA-L-discriminator (335M) ( 9 ) | 77.07 | 66.77 | 0.094 | 25.52 | 34.67 | 0.126 |
| Flan-T5-base (223M) ( 8 ) | 82.00 | 76.54 | 0.064 | 55.14 | 67.84 | 0.125 |
Appendix figures & tables31 assets
Supplementary material from the paper’s appendix.
Appendix
| Pool | Intended Semantics |
|---|---|
| Supports that concept is present | |
| Supports that concept is absent | |
| Topically related to concept but not supportive | |
| Easy non-support evidence for concept |
| Diagnostic | Value |
|---|---|
| Total verifier examples | 18,397 |
| Positive fraction | 0.17 |
| Wrong-state fraction among negatives | 0.25 |
| Mean examples per concept | 2628.14 |
| Mean examples per case | 3.20 |
| Fraction of present-state claims | 0.55 |
| Category | Gold State / Claim | Label | Evidence Excerpt |
|---|---|---|---|
| gold=absent / claim=pleural effusion is absent | 1 | Classically demonstrated in M-mode, the appearance of which the moniker is derived, it is specific for the identification of a pleural effusion, although ins… | |
| gold=present / claim=cardiomegaly is absent | 0 | There is no associated cardiomegaly, and the radiographic changes often rapidly disappear in patients who survive the acute event. | |
| gold=present / claim=cardiomegaly is present | 0 | The hematoma itself is typically relatively small, thus fat saturated sequences are crucial by pinpointing the common surrounding soft tissue edema. | |
| gold=present / claim=cardiomegaly is absent | 0 | It shows a non-uniform distribution around the heart. |
| Stage | Count |
|---|---|
| Reports initially ingested from MIMIC-CXR | 227,835 |
| Reports retained after deterministic inclusion criteria | 227,835 |
| Reports with valid Findings and Impression sections | 37,811 |
| Unique patients retained | 20,237 |
| Statistic | Value |
| Retained reports yielding at least one valid concept-state claim | 31,225 |
| Total retained report-concept pairs before shortcut filtering | 55,262 |
| Report-concept pairs excluded by shortcut filtering | 46,346 |
| Retained report-concept pairs in the main benchmark | 8,916 |
| Mean retained concepts per report | 1.2 |
| Distinct pathology concepts in the fixed claim space | 10 |
| Statistic | Value |
|---|---|
| Mean tokens per case context | 93.0 |
| Standard deviation | 31.9 |
| Median | 87.0 |
| 95th percentile | 150.0 |
| Maximum | 360.0 |
| Statistic | Value |
|---|---|
| Snapshot date | March 1, 2026 |
| Articles in raw snapshot | 17,293 |
| Retained articles after initial preprocessing and deduplication | 14,391 |
| Articles represented in the cleaned sentence universe | 14,199 |
| Total retained evidence sentences | 55,624 |
| Mean tokens per sentence | 25.4 |
| Subset | Articles | Evidence Sentences |
|---|---|---|
| Training/validation article subset | 11,361 | 44,390 |
| Held-out article subset | 2,838 | 11,234 |
| Statistic | Value |
| Mean concept coverage | 115.0 |
| Median concept coverage | 79.0 |
| Minimum concept coverage | 7 |
| Maximum concept coverage | 326 |
| Concepts with non-empty support-present pool | 6 |
| Concepts with non-empty support-absent pool | 3 |
| Statistic | Train | Validation | Test |
|---|---|---|---|
| Total verifier examples | 14,173 | 1,659 | 2,565 |
| Positive examples ( ) | 2,369 | 266 | 446 |
| Negative examples ( ) | 11,804 | 1,393 | 2,119 |
| Positive fraction | 0.2 | 0.2 | 0.2 |
| Wrong-state negative fraction | 0.2 | 0.2 | 0.2 |
| Statistic | Value |
|---|---|
| Training token budget | 1024 |
| Mean tokens per verifier input | 191.4 |
| Standard deviation | 39.0 |
| Median | 186.0 |
| 95th percentile | 262.0 |
| Fraction exceeding 1024 tokens | 0.0 |
| Training | Validation | Test | |
|---|---|---|---|
| Patients | 15,283 | 1,923 | 3,031 |
| Reports | 28,683 | 3,608 | 5,520 |
| Retained report-concept pairs | 6,840 | 844 | 1,232 |
| Verifier examples | 14,173 | 1,659 | 2,565 |
| Stage | Count |
|---|---|
| Reports initially ingested from CheXpert-Plus | 223,460 |
| Reports retained after deterministic inclusion criteria | 55,590 |
| Retained report-concept pairs | 23,249 |
| Verifier examples in external evaluation artifact | 20,088 |
| Statistic | Value |
|---|---|
| Mean tokens per case context | 104.7 |
| Standard deviation | 50.0 |
| Median | 92.0 |
| 95th percentile | 202.0 |
| Maximum | 561.0 |
| Hyperparameter | Value |
|---|---|
| Backbone | ModernBERT-large ( 61 ) |
| Training objective | Weighted binary cross-entropy |
| Class weighting | Inverse-frequency |
| Training token budget | 1024 |
| Evidence sentences used in training | 2 |
| Optimizer | AdamW |
| Metric | S1: Case + Claim | S2: Evidence + Claim | S3: Case + Evidence + Claim |
|---|---|---|---|
| AUROC | 59.90 1.60 [57–63] | 82.63 0.77 [81–84] | 97.43 0.27 [97–98] |
| AUPRC | 26.23 1.87 [23–30] | 35.11 1.55 [32–38] | 87.78 1.56 [85–91] |
| F1 score | 32.21 1.83 [28–35] | 62.79 1.54 [60–66] | 78.72 1.94 [74–82] |
| Accuracy | 65.74 6.61 [56–78] | 79.40 0.80 [78–81] | 91.22 1.01 [88–93] |
| Bal. Acc. | 58.40 1.20 [56–61] | 87.53 0.46 [87–88] | 92.03 0.64 [91–93] |
| Sensitivity | 47.14 10.52 [26–63] | 100.00 0.00 [100–100] | 93.28 1.48 [91–97] |
| Comparison | AUROC | AUPRC | F1 | Bal. Acc. | Brier |
|---|---|---|---|---|---|
| S2 S1 | 22.73 | 8.88 | 30.58 | 29.13 | 0.054 |
| S3 S1 | 37.53 | 61.55 | 46.51 | 33.63 | -0.141 |
| S3 S2 | 14.80 | 52.67 | 15.93 | 4.50 | -0.195 |
| Metric | Correct, Source-Matched | Correct, Held-Out Articles | Swapped Evidence |
|---|---|---|---|
| AUROC | 97.43 0.27 [97–98] | 97.24 0.33 [97–98] | 55.62 1.50 [53–59] |
| AUPRC | 87.78 1.56 [85–91] | 74.18 3.20 [68–80] | 21.73 1.54 [19–25] |
| F1 score | 78.72 1.94 [74–82] | 77.94 1.91 [74–82] | 29.77 2.84 [23–33] |
| Accuracy | 91.22 1.01 [88–93] | 92.87 0.65 [92–94] | 52.38 11.86 [39–78] |
| Bal. Acc. | 92.03 0.64 [91–93] | 95.86 0.33 [95–97] | 55.34 1.06 [53–57] |
| Sensitivity | 93.28 1.48 [91–97] | 99.87 0.34 [99–100] | 59.87 18.72 [20–80] |
| Metric | Top-1 | Top-2 | Top-3 | Top-4 | Top-5 |
|---|---|---|---|---|---|
| AUROC | 90.70 0.85 | 97.43 0.27 | 97.49 0.27 | 97.50 0.27 | 97.50 0.27 |
| AUPRC | 77.08 1.94 | 87.78 1.56 | 88.03 1.55 | 88.07 1.55 | 88.07 1.55 |
| F1 score | 72.94 1.91 | 78.72 1.94 | 78.83 1.81 | 78.86 1.82 | 78.86 1.82 |
| Accuracy | 89.87 0.88 | 91.22 1.01 | 91.24 0.88 | 91.26 0.89 | 91.26 0.89 |
| Bal. Acc. | 85.37 1.00 | 92.03 0.64 | 92.21 0.63 | 92.22 0.64 | 92.22 0.64 |
| Sensitivity | 78.48 2.16 | 93.28 1.48 | 93.70 1.31 | 93.68 1.32 | 93.68 1.32 |
| Training-time budget | Condition | AUROC | AUPRC | F1 | Brier |
|---|---|---|---|---|---|
| Random | Source-matched | 96.12 | 84.21 | 71.95 | 0.061 |
| Random | Source-matched | 93.43 | 78.53 | 67.17 | 0.077 |
| Random | Source-matched | 96.10 | 84.68 | 76.99 | 0.067 |
| Random | Held-out | 97.44 | 77.14 | 77.73 | 0.073 |
| Random | Held-out | 96.29 | 67.76 | 77.59 | 0.086 |
| Random | Held-out | 97.96 | 83.92 | 77.09 | 0.067 |
| Metric | S1: Case + Claim | S2: Evidence + Claim | S3: Case + Evidence + Claim |
|---|---|---|---|
| AUROC | 59.90 1.60 [57–63] | 79.81 0.75 [78–81] | 93.46 0.41 [93–94] |
| AUPRC | 26.23 1.87 [23–30] | 42.46 1.35 [40–45] | 78.09 1.70 [75–81] |
| F1 score | 32.21 1.83 [28–35] | 66.45 1.14 [64–69] | 75.15 1.27 [73–78] |
| Accuracy | 65.74 6.61 [56–78] | 74.75 0.79 [73–76] | 84.57 1.01 [83–87] |
| Bal. Acc. | 58.40 1.20 [56–61] | 83.16 0.49 [82–84] | 87.45 0.60 [86–89] |
| Sensitivity | 47.14 10.52 [26–63] | 100.00 0.00 [100–100] | 93.20 1.69 [90–96] |
| Metric | Correct, Source-Matched | Correct, Held-Out Articles | Swapped Evidence |
|---|---|---|---|
| AUROC | 93.46 0.41 [93–94] | 88.37 0.70 [87–90] | 53.18 1.30 [51–56] |
| AUPRC | 78.09 1.70 [75–81] | 61.23 2.22 [57–66] | 28.52 1.39 [26–31] |
| F1 score | 75.15 1.27 [73–78] | 72.13 1.42 [69–75] | 31.69 5.77 [21–41] |
| Accuracy | 84.57 1.01 [83–87] | 81.32 1.04 [79–83] | 60.37 11.20 [35–72] |
| Bal. Acc. | 87.45 0.60 [86–89] | 86.47 0.68 [85–88] | 53.62 0.85 [52–55] |
| Sensitivity | 93.20 1.69 [90–96] | 96.76 1.12 [94–99] | 40.13 22.16 [14–89] |
| Comparison | AUROC | AUPRC | F1 | Bal. Acc. | Brier |
|---|---|---|---|---|---|
| S3 Source-Matched S1 | 33.56 | 51.86 | 42.94 | 29.05 | -0.072 |
| S3 Source-Matched S2 | 13.65 | 35.63 | 8.70 | 4.29 | -0.168 |
| S3 Held-Out S3 Source-Matched | -5.09 | -16.86 | -3.02 | -0.98 | 0.064 |
| S3 Swapped S3 Source-Matched | -40.28 | -49.57 | -43.46 | -33.83 | 0.223 |
| Metric | Flan-T5-L | ModernBERT-L | RoBERTa-L | ELECTRA-L | Flan-T5-B |
|---|---|---|---|---|---|
| Parameters (M) | 751 | 395 | 355 | 335 | 223 |
| MIMIC-CXR: Source-Matched Evidence | |||||
| AUROC | 97.11 0.29 | 97.43 0.27 | 91.54 0.94 | 94.79 0.41 | 97.11 0.29 |
| AUPRC | 84.76 1.89 | 87.78 1.56 | 78.18 1.90 | 77.07 2.11 | 82.00 2.28 |
| F1 score | 75.33 2.49 | 78.72 1.94 | 63.50 2.90 | 66.77 1.98 | 76.54 2.10 |
| Accuracy | 88.98 1.49 | 91.22 1.01 | 81.06 2.43 | 83.18 1.42 | 89.86 1.16 |
| Metric | ModernBERT-B | Longformer-B | BiomedBERT |
|---|---|---|---|
| Parameters (M) | 149 | 148 | 109 |
| MIMIC-CXR: Source-Matched Evidence | |||
| AUROC | 96.56 0.33 | 96.68 0.37 | 96.83 0.31 |
| AUPRC | 82.21 2.17 | 85.55 1.65 | 84.83 1.82 |
| F1 score | 76.40 3.19 | 74.30 1.72 | 75.97 1.95 |
| Accuracy | 90.23 2.11 | 88.46 0.91 | 89.72 1.07 |
| ID | Claim | Cat. | Label | S3 | Held-Out | S2 | S1 | Swapped | Interpretation |
|---|---|---|---|---|---|---|---|---|---|
| P1 | atelectasis is present | 1 | 0.992 | 0.898 | 0.012 | 0.041 | 0.000 | Canonical positive support with strong evidence dependence and good transfer to unseen evidence articles. | |
| P2 | pleural effusion is present | 1 | 0.986 | 0.993 | 0.002 | 0.001 | 0.001 | Near-ideal positive profile: strong under both correct-evidence conditions and near-zero under all destructive or restricted-input conditions. | |
| P3 | pulmonary edema is present | 1 | 0.999 | 0.000 | 0.002 | 0.021 | 0.000 | Positive support under source-matched evidence, but complete collapse under held-out evidence, illustrating source-shift sensitivity at the instance level. |
| ID | Claim | Cat. | Label | S3 | Held-Out | S2 | S1 | Swapped | Interpretation |
|---|---|---|---|---|---|---|---|---|---|
| N1 | pleural effusion is absent | 0 | 0.000 | 0.000 | 0.991 | 0.001 | 0.000 | Wrong-state counterfactual negative: evidence-only verification is highly confident, but the full verifier correctly rejects support once the case is included. | |
| N2 | fracture is present | 0 | 0.000 | 0.000 | 0.000 | 0.003 | 0.000 | Hard non-support negative with uniformly near-zero support across all conditions. | |
| B1 | atelectasis is present | 1 | 0.998 | 0.000 | 0.057 | 0.985 | 0.000 | Boundary case with strong residual local solvability despite shortcut filtering. The full verifier remains correct, but the example is not evidence-dependent in the strongest possible sense. | |
| B2 | pleural effusion is present | 1 | 1.000 | 0.000 | 0.002 | 0.001 | 1.000 | Boundary case in which swapped evidence does not reduce support, showing that aggregate degradation under swapping does not imply collapse on every individual row. |
| Field | Value |
|---|---|
| Target concept | Pleural effusion |
| Findings-derived case context | Portable chest radiograph with right pigtail catheter, no pneumothorax, minimal right costophrenic blunting without gross effusion, low lung volumes, bilateral non-specific opacities compatible with atelectasis, and no gross left-sided effusion visible in the imaged field |
| Impression-derived gold state | absent |
| Structured question | Does the study show no pleural effusion? |
| Structured claim | Pleural effusion is absent |
| Label source text | No gross effusion |
| Category | Gold state / Claim state | Evidence source type | Label | Evidence text |
|---|---|---|---|---|
| absent / absent | support absent | 1 | Classically demonstrated in M-mode, the appearance of which the moniker is derived, it is specific for the identification of a pleural effusion, although insensitive, as it may be absent with dense or heavily septated collections. | |
| absent / present | support present | 0 | Refer to the article “pleural effusion volume (ultrasound)” for more information. CT scanning is excellent at detecting small amounts of fluid and is also often able to identify the underlying intrathoracic causes. | |
| absent / present | nonsupport hard | 0 | Non-specific changes with ground-glass opacity have been the most commonly reported findings with nodular consolidation described in a lesser number of patients. Involvement can often be bilateral. | |
| absent / absent | nonsupport easy | 0 | On chest radiographs, they are seen to cross normal vascular markings and extend radially from the hilum to the upper lobes. |