Organizations: University of Illinois Chicago, Chicago, IL, USA · Manteia Technologies Co., Ltd, Xiamen, China · University of Illinois Urbana-Champaign, Champaign, IL, USA · University of California Los Angeles, Los Angeles, CA, USA
Abstract
Conformal triage converts predictive scores into deployment actions that either release a case, flag it for urgent attention, or defer it to human review. Under prevalence shift, however, the usual summaries of marginal coverage and human-review rate can miss the safety-critical question of whether patients who truly experience the target event are released without review. To address this gap, we introduce a leakage-aware deployment audit for release-side conformal triage. It first assigns target subjects to three non-overlapping roles: prevalence correction, conformal calibration, and held-out release-safety evaluation. This separation then lets the audit evaluate release directly: how many event-positive patients are cleared without review, whether the pilot has enough event labels for calibration, and how the safety-review trade-off shifts. Applying this audit to a retrospective NSCLC pilot shows why lower review can be misleading: after prevalence correction, the pooled conformal branch lowers review by releasing more patients, some of whom are event-positive. Within the audit, the classwise branch acts as a scarcity diagnostic: the pilot has too few event labels to certify safe low-review release.
Conformal risk control (CRC) provides distribution-free guarantees on segmentation quality by calibrating a prediction-set threshold on held-out data. In federated deployments, the standard approach pools calibration scores across sites into a single threshold. We provide the first quantification, on real multi-institutional brain tumor data (FeTS-2022, 1,251 subjects, 20 institutions), showing that this naive pooled CRC protects the average hospital but violates coverage at 40% of individual institutions, with the worst site exceeding the target false-negative rate by 7.8 percentage points. The naive alternative, per-site local CRC, largely restores coverage but inflates prediction sets by 83x, rendering them clinically useless. We propose a shrinkage-based federated CRC protocol: each site transmits only its empirical risk curve (G scalars) to a server, which computes a shrinkage-regularized threshold per site. A single hyperparameter n0 smoothly trades worst-case coverage for prediction-set efficiency; leave-one-site-out sensitivity analysis identifies n0=19, achieving 2.7/20 violations at 2.0x stretch. We further show that direct Lagrangian optimization of coverage budgets fails, concentrating risk on vulnerable hospitals, and that the finite-sample correction term is essential: removing it triples violations. The marginal CRC guarantee is preserved by construction under the stated site-mixture assumption; per-site coverage is validated across four targets with three seeds. No patient-level images, masks, or per-volume scores leave any site.
We consider the problem of uncertainty quantification for a pretrained classification model deployed under unknown distribution shift. We propose Audited Conformal Prediction (ACP), a method that leverages a small labeled dataset from the target population to train an auxiliary audit model identifying inputs where the legacy model is likely to fail. By integrating the audit model's outputs into the conformal prediction framework, ACP produces prediction sets that guarantee marginal coverage while achieving substantially higher conditional coverage in practice than existing approaches. We develop and analyze two complementary integration strategies -- one targeting marginal coverage with improved conditional performance, the other providing explicit group-conditional coverage guarantees -- and establish theoretical guarantees for both. Experiments on synthetic and real-world datasets validate the method and illustrate trade-offs between prediction set size and conditional coverage.
Trimming suspicious calibration points is a common response to contamination in conformal prediction. Its effect on clean-target coverage, however, is governed by the retained law induced by trimming, not by the contamination level alone. We analyse fixed-threshold trimming as conditioning rather than purification. It replaces the contaminated calibration law with a retained law, reducing clean-target coverage to a one-dimensional score-CDF transfer problem with an exact finite-sample identity. A componentwise bound on the transfer gap gives a population-level diagnostic. This separates a clean-side covariance cost from a retained-contamination cost, governed by the dirty-to-clean retention ratio. Trimming helps when the anomaly score separates retention probabilities while remaining score-neutral on the clean population. Otherwise, it cannot substantially reduce contamination through the retained mixture coefficient. We also give finite-sample certificate templates that provide numerical guarantees under independent audit.