MLPTR-CC: Multi-label Pathology Test Recommendation using Classifier Chains and SHAP

There is growing interest in using machine learning (ML) to support clinical diagnosis, but most approaches rely on static, fully observed datasets and fail to reflect the sequential, resource-aware reasoning clinicians use in practice. Diagnosis remains complex and error prone, especially in high-pressure or resource-limited settings, underscoring the need for frameworks that help clinicians make timely and cost-effective decisions. We propose ACTMED (Adaptive Clinical Test selection via Model-based Experimental Design), a diagnostic framework that integrates Bayesian Experimental Design (BED) with large language models (LLMs) to better emulate real-world diagnostic reasoning. At each step, ACTMED selects the test expected to yield the greatest reduction in diagnostic uncertainty for a given patient. LLMs act as flexible simulators, generating plausible patient state distributions and supporting belief updates without requiring structured, task-specific training data. Clinicians can remain in the loop; reviewing test suggestions, interpreting intermediate outputs, and applying clinical judgment throughout. We evaluate ACTMED on real-world datasets and show it can optimize test selection to improve diagnostic accuracy, interpretability, and resource use. This represents a step toward transparent, adaptive, and clinician-aligned diagnostic systems that generalize across settings with reduced reliance on domain-specific data.

Mammography is an essential tool for breast cancer detection, with millions of examinations conducted annually. However, publicly available high-quality mammography datasets for AI development remain limited in both scale and annotation richness, particularly regarding pathological subtype coverage and structured diagnostic reasoning annotations. In this paper, we present MammoExpert, the first mammography dataset with Chain-of-Thought reasoning annotations across three diagnostic phases: (i) primal observation, (ii) factual assessment, and (iii) diagnostic synthesis. Comprising 2,379 mammography images covering 67 WHO-classified histopathology subtypes, each exam provides 42 radiographic features annotated by nine senior radiologists. We evaluate its performance on the breast lesion classification task, demonstrating superior accuracy and reasonability compared to existing classification models. Combining public dataset CBIS-DDSM with MammoExpert yields 7.1% classification accuracy improvement, while the training model to learn CoT reasoning achieves another 4% gain on the MammoExpert test set. Similar improvements are observed on INBreast and Vindr datasets, where the full approach yields accuracy gains of 6.9% and 6.7%, respectively. MammoExpert can serve as a benchmark for interpretable breast lesion diagnosis through explicit CoT reasoning.

Diagnostic prediction and clinical reasoning are critical tasks in healthcare applications. While Large Language Models (LLMs) have shown strong capabilities in commonsense reasoning, they still struggle with diagnostic reasoning due to limited domain knowledge. Existing approaches often rely on internal model knowledge or static knowledge bases, resulting in knowledge insufficiency and limited adaptability, which hinder their capacity to perform diagnostic reasoning. Moreover, these methods focus solely on the accuracy of final predictions, overlooking alignment with standard clinical reasoning trajectories. To this end, we propose MultiDx, a two-stage diagnostic reasoning framework that performs differential diagnosis by analyzing evidence collected from multiple knowledge sources. Specifically, it first generates suspected diagnoses and reasoning paths by leveraging knowledge from web search, SOAP-formatted case, and clinical case database. Then it integrates multi-perspective evidence through matching, voting, and differential diagnosis to generate the final prediction.~Extensive experiments on two public benchmarks demonstrate the effectiveness of our approach.