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8 papers in the last four weeks, down 50% on the four weeks before. 0.1% of all new papers.

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Latest papers 212

May 25, 2026cs.CV

Cross-Stage Attention Multi-Expert Network for Radiologist-Inspired Breast Ultrasound Diagnosis

Breast ultrasound imaging is an important noninvasive method for early breast cancer diagnosis, but automatic benign/malignant classification remains challenging due to tumor heterogeneity, blurred boundaries, and data imbalance. To improve feature representation and classification accuracy, this paper proposes the Cross-Stage Attention Mixture-of-Experts Network (CSA-MoE-Net). It adopts a Cross-Stage Attention-enhanced ResNet-18 as the backbone, in which the Cross-Stage Attention module adaptively recalibrates multi-level features, thereby enhancing key tumor features and suppressing redundancy. A three-branch Mixture of Experts (MoE) Block learns complementary features from the Whole Tumor Image, Tumor Core, and Boundary, and an Adaptive Gating Network fuses them to capture morphological, textural, and contextual information. The fused features are denoted as Fused Expert Feature (FEF) in the architecture. Experiments on a balanced dataset of 2,129 breast ultrasound images show that, averaged over 20 independent runs, the model achieves an accuracy of 96.33%, precision of 94.09%, recall of 98.53%, F1-score of 96.25%, and AUC of 99.50%. Compared to the baseline ResNet-18, these metrics improve by 3.01, 0.70, 5.37, 2.98, and 5.42 percentage points, respectively. The proposed mechanism requires no invasive modification and can be seamlessly embedded into VGG-16, DenseNet-121, etc., yielding stable performance gains, thus providing reliable support for computer-aided diagnosis.

Xinyang Zhai, Chong Yang, Ruizhi Zhang

Mixture of Experts Medical Image Classification Ultrasound Imaging Oncology Attention Mechanisms

May 24, 2026stat.AP

Multimodality Stacking with Blockwise missing values and application to the PIONeeR biomarkers study for prediction of resistance to immunotherapy

Integrating multimodal datasets in clinical oncology is frequently hindered by high dimensionality and blockwise missingness, where entire data sources are unavailable for specific patient subsets. Standard survival models often struggle with these gaps, leading to biased results or patient exclusion. We introduce Multimodality Stacking with Blockwise missing values (MSB), a late-fusion framework for survival analysis that independently models modality-specific features before aggregating predictions via a cross-validated stacking meta-learner. MSB was validated on the PIONeeR study (n=443 patients, 378 biomarkers across eight heterogeneous sources) to predict progression-free survival in advanced non-small cell lung cancer patients receiving immunotherapy. MSB yielded higher predictive performance (C-index) than baseline algorithms. Improvements varied by baseline strength: linear models showed a 15.9% increase (p<0.001 for the Wilcoxon signed-rank test), random survival forests gained 5.4% (p=0.002), and gradient boosting methods improved by 2.1% (p=0.030). Beyond discrimination, MSB reduced the generalization gap (train-test difference in 5 folds cross-validation repeated 3 times: 0.055 vs 0.380 for linear models). Permutation importance analysis identified routine laboratory markers, clinical features, and PD-L1 expression as primary predictive drivers. Missing block indicators showed negligible importance, suggesting the model learned from biomarker values rather than data availability patterns. MSB provides a statistically validated framework for multimodal survival prediction with blockwise missingness. By enabling systematic biomarker evaluation without requiring complete data, MSB offers a practical tool for predictive modeling in biomedical research, pending external validation. Implementation is available at https://github.com/MohamedBoussena/MSB under Inria license.

Mohamed Boussena, Florence Monville, Jacques Fieschi-Meric +8

Inria – Inserm team COMPO, COMPutational pharmacology and clinical Oncology, Centre Inria Sophia Antipolis - M´editerran´ee, Centre de Recherches en Canc´erologie de Marseille, Inserm U1068, CNRS UMR7258, Institut Paoli-Calmettes, Pharmacy faculty, Aix-Marseille University · Veracyte SAS, Marseille, France · Assistance Publique-Hˆopitaux de Marseille (APHM), Marseille, France +4

Missing-Modality Learning Cancer Survival Prediction Survival Analysis Clinical Outcome Prediction Oncology Multimodal Survival Analysis+1

May 23, 2026cs.AI

ConceptM $^3$ oE: Concept-Guided Multimodal Mixture of Experts for Interpretable Computational Pathology

Healthcare models are transitioning from unimodal prediction toward multimodal reasoning over heterogeneous diagnostic inputs. In computational pathology, for complex tumor subtypes where morphology alone can be challenging to distinguish, pathology reports and molecular measurements may provide additional diagnostic evidence alongside whole-slide images, yet existing models often fail to clarify how diverse signals assemble into recognizable diagnostic concepts. We propose ConceptM

^3

oE (Concept Multimodal MoE), which embeds concept formation directly within interaction-aware mixture-of-experts (MoE) pathways. The architecture decomposes evidence into modality-specific, redundant, and synergistic experts, which are then projected into structured concept bottlenecks mapping latent features to a hierarchy of morphology and biomarker concepts. To prevent the information loss typical of interpretable bottlenecks, we utilize residual pathways within each expert to allow task-relevant signals to flow both through the concepts and directly to the final task prediction, so that high performance is maintained alongside interpretability. Across an institutional pediatric brain tumor cohort and a public glioma cohort, the framework delivers competitive performance to unconstrained models while producing reasoning traces validated by an independent neuropathologist. In data-limited regimes, ConceptM

^3

oE improves limited-data performance, increasing macro-F1 from 56.41% to 66.70% at small training sizes compared to non-concept-informed baselines, while also showing faster training convergence consistent with the regularizing effect of concept learning. This work offers a scalable path toward high-performance medical AI that is inherently verifiable and better aligned with the complex decision-making of clinical practice.

Xuan Wang, Zhongling Xu, Gopi Kannedhara +13

University of Texas at Austin, Austin, TX, USA · University of North Carolina at Chapel Hill, NC, USA · Dell Children’s Medical Center, Austin, TX, USA +2

Computational Pathology Concept Bottleneck Models Healthcare Interpretable ML Multimodal Classification Oncology+4

May 22, 2026cs.CV

Exploiting Longitudinal Context in Clinician-Verified Interactive Lesion Tracking

Tracking tumor lesions across serial CT scans is essential for oncological response assessment. Existing automated methods face a fundamental trade-off: end-to-end trackers achieve high automation but offer no opportunity to correct silent tracking failures, while decoupled registration-segmentation pipelines permit user verification yet discard the lesion's prior appearance, limiting accuracy in ambiguous cases. In this work, we propose a Verified Tracking paradigm: a clinician verifies a registration-proposed prompt, which the model leverages alongside the baseline lesion appearance to resolve segmentation ambiguities. We present a unified framework combining early spatial prompt fusion with latent temporal difference weighting for longitudinally-informed segmentation. To address data scarcity, we leverage large-scale synthetic pretraining, proving essential for exploiting longitudinal context, improving performance by up to 4.5 Dice points over training from scratch. Our approach secured first place in the MICCAI autoPET IV challenge. We further curate and release PanTrack, a new longitudinal pancreatic cancer benchmark, to assess out-of-distribution generalization. Experiments show that our model outperforms prior work in both fully automatic and the proposed verified tracking setting offering a clinically safe middle ground between automation and control. Code, model and dataset will be released at https://github.com/MIC-DKFZ/LongiSeg

Yannick Kirchhoff, Maximilian Rokuss, Daniel Philipp Mertens +5

German Cancer Research Center (DKFZ) Heidelberg, Division of Medical Image Computing, Germany · Faculty of Mathematics and Computer Science, Heidelberg University, Germany · HIDSS4Health – Helmholtz Information and Data Science School for Health, Karlsruhe/Heidelberg, Germany +3

Interactive Medical Image Segmentation Medical Imaging Longitudinal Medical Image Analysis Medical Image Segmentation Oncology Medical Image Benchmarks

May 20, 2026cs.CV

ProtoPathway: Biologically Structured Prototype-Pathway Fusion for Multimodal Cancer Survival Prediction

We introduce ProtoPathway, an interpretable-by-design multimodal framework for cancer survival prediction that unifies whole slide imaging and transcriptomics through encoders producing biologically grounded representations on both sides of the fusion. On the histopathology side,

K

learnable morphological prototypes, trained end-to-end with the survival objective, serve as the slide representation itself: patches flow into prototype tokens via soft assignment, compressing variable-length patch sets into fixed task-adaptive tokens. On the genomic side, a bipartite graph neural network encodes gene expression within the Reactome pathway hierarchy, producing pathway embeddings that reflect both constituent genes and their broader biological context through bidirectional message passing over a shared gene--pathway graph. Cross-modal attention then operates over a compact prototype

\times

pathway matrix in which prototypes query pathways, modeling the biological direction in which molecular programs give rise to tissue morphology. Because both axes carry stable task-learned identity, the attention matrix is itself an interpretability output, yielding native inference-time attribution across the full biological hierarchy, from genes through pathways and prototypes to spatial tissue maps. We evaluate on five TCGA cancer cohorts, demonstrating competitive or superior survival prediction with substantially improved biological interpretability and reduced computational cost, with interpretability claims validated through fold-stratified rank-based population-level analysis. Our source code, model weights, and Reactome pathways, together with a unified codebase reimplementing all multimodal survival baselines under identical preprocessing and evaluation, are available at: https://github.com/AmayaGS/ProtoPathway.

Amaya Gallagher-Syed, Costantino Pitzalis, Myles J. Lewis +2

Queen Mary University of London

Cancer Survival Prediction Oncology Multimodal Survival Analysis Explainable Medical Image Analysis Multimodal Fusion Whole-Slide Image Analysis

May 20, 2026cs.CV

HDMoE: A Hierarchical Decoupling-Fusion Mixture-of-Experts Framework for Multimodal Cancer Survival Prediction

Multimodal survival prediction, a crucial yet challenging task, demands the integration of multimodal medical data (\eg Whole Slide Images (WSIs) and Genomic Profiles) to achieve accurate prognostic modeling. Given the inherent heterogeneity across modalities, the feature decoupling-fusion paradigm has emerged as a dominant approach. However, these methods have the following shortcomings: (1) fail to reduce the redundant information of modality features before decoupling, which negatively affects the feature decoupling and fusion effect;(2) lack the ability to model the fine-grained relationships of the features and capture the local information interactions between intra- and inter-modality features. To address these issues, we propose a \underline{H}ierarchical \underline{D}ecoupling-Fusion \underline{M}ixture-\underline{o}f-\underline{E}xperts (HDMoE) framework with two levels of MoE and \underline{R}andom \underline{F}eature \underline{R}eorganization (RFR) modules.In the first-level MoE, shared experts and routed experts are employed to remove redundant information and extract fine-grained specific features within each modality, while the second-level MoE facilitates fine-grained inter-modality feature decoupling. Besides, we design two RFR modules following each level of MoE to finely fuse intra- and inter-modality features, which can help the model capture more fine-grained relationships between modalities. Extensive experimental results on our private Liver Cancer (LC) and three TCGA public datasets confirm the effectiveness of our proposed method. Codes are available at https://github.com/ZJUMAI/HDMoE.

Huayi Wang, Haochao Ying, Yuyang Xu +5

Zhejiang University Hangzhou, China · Xinjiang University Urumqi, China · Hangzhou City University Hangzhou, China +1

Cancer Survival Prediction Survival Analysis Oncology Multimodal Survival Analysis Mixture-of-Experts Models Multimodal Fusion

May 20, 2026cs.LG

Training distribution determines the ceiling of drug-blind cancer sensitivity prediction

Precision oncology requires predicting which drugs will suppress a specific tumor from its molecular profile, but drug-blind sensitivity prediction has plateaued despite increasingly complex drug representations. Here we show that this stagnation reflects a metric artifact rather than a representational bottleneck. The standard benchmark, global Pearson r, is dominated by between-drug potency differences that a trivial drug-mean predictor captures without any cell-specific learning. Per-drug Pearson r, which isolates within-drug cell ranking, reveals that no drug encoding improves over cell-only features across four independent datasets. A controlled experiment channeling mechanism-of-action identity as either a drug feature or a training-distribution constraint identifies the cause. Supplying MoA as a feature yields negligible benefit, whereas using it to stratify training raises per-drug r substantially for targeted kinase inhibitors, because pan-cancer co-training suppresses pathway-specific sensitivity signals. Mechanism-stratified training and response matching from pilot observations provide two deployable strategies that together recover the principal sources of predictive gain in drug-blind sensitivity prediction.

Taekyung Heo

Training Data Selection Clinical Prediction Oncology Molecular Representation Learning

May 18, 2026cs.CV

Beyond Morphology: Quantifying the Diagnostic Power of Color Features in Cancer Classification

In histopathology, human experts primarily rely on color as a means of enhancing contrast to interpret tissue morphology, whereas machine vision models process color as raw statistical information. This distinction raises a fundamental question: to what extent can pixel intensity alone, independent of structural and morphological cues, support cancer classification? To address this question, we systematically evaluated the standalone discriminative power of global color features while deliberately excluding all morphological information. Specifically, we extracted statistical color moments and discretized RGB and HSV color histograms, and assessed their performance across ten diverse experimental settings using classical machine learning classifiers. Our results demonstrate that color features alone can achieve strong performance in binary diagnostic tasks (e.g., benign versus malignant), with classification accuracies reaching up to 89%. This performance is likely attributable to global chromatic shifts associated with malignancy. Importantly, these simple color-based representations consistently outperformed random baselines by a substantial margin, indicating that raw color distributions encode a non-random and diagnostically relevant signal for cancer detection. Consequently, this study suggests that simple, computationally efficient color features can serve as an effective pre-screening tool. By identifying samples with strong chromatic indicators of malignancy, these lightweight models could function as a first-pass triage system, reducing the computational burden on complex deep learning architectures.

Farnaz Kheiri, Shahryar Rahnamayan, Masoud Makrehchi

Dept. of Electrical, Computer and Software Engineering Ontario Tech University Oshawa, Ontario, Canada · Dept. of Engineering Brock University St. Catharines, Ontario, Canada

Computational Pathology Oncology Histopathology Image Classification

May 16, 2026cs.CV

UCSF-PDGM-VQA: Visual Question Answering dataset for brain tumor MRI interpretation

Brain tumor diagnosis is largely dependent on Magnetic Resonance Imaging (MRI) evaluation, which requires radiologists to synthesize thousands of images across multiple 3D sequences and longitudinal studies. This process requires advanced neuro-radiology training, poses substantial cognitive load, and is highly time-consuming. Despite increasing demands in radiology, this expertise is difficult to scale, straining the current health systems. Vision-Language Models (VLMs) provide an opportunity to reduce this burden through a semi-automated, interactive interpretation of complex brain MRIs. However, they are currently underutilized in neuro-oncology due to a lack of specialized benchmarks for evaluating them. We introduce a clinically relevant visual question answering (VQA) benchmark -- the UCSF-PDGM-VQA dataset -- consisting of 2,387 QA pairs from 473 glioma-related MRI studies in the public UCSF-PDGM dataset. We further establish a performance baseline for six state-of-the-art vision-language models (VLMs) and one large language model on this dataset. We find that current models are incapable of effectively processing multi-sequence, 3-dimensional MRI scans, thus resulting in a suppression of visual features and over-reliance on language priors, causing modality collapse. These findings underscore a critical deficiency in current model reliability and safety within clinical settings, necessitating the development of robust, domain-specific VLMs.

Shiv Ghosh, Junayd Lateef, Chih-Hua Liu +3

Fung Institute for Engineering Leadership University of California, Berkeley Berkeley, CA 94709 · Department of Radiology University of California, San Francisco San Francisco, CA 94158 · Department of Radiology University of California, San Francisco San Francisco, CA 94143 +1

VLM Evaluation Medical VQA Oncology Medical Image Benchmarks

May 15, 2026cs.CV

Diffusion Attention Expert Model for Predicting and Semi-automatic Localizing STAS in Lung Cancer Histopathological Images

Accurate intraoperative and postoperative diagnosis of spread through air spaces (STAS) is essential for guiding surgical decisions and postoperative management in lung cancer. However, histopathological assessment is labor-intensive and is prone to missed or incorrect diagnoses. We propose a Diffusion Attention Expert Model (DAEM) to detect STAS in frozen sections (FSs) and paraffin sections (PSs). Its diffusion attention expert module leverages full attention aggregation to learn multi-scale features from histopathological images, while a dual-branch architecture strengthens multi-scale feature representation. On an internal dataset, DAEM achieves AUCs of 0.8946 for FSs and 0.9112 for PSs. Validation on external multi-center datasets from eight institutions demonstrates strong generalizability and interpretability. Using tumor microenvironment (TME) features in PSs, we further enable semi-automatic measurement of STAS location and its distance from the primary tumor. Several quantitative TME metrics are identified as potential biomarkers for STAS, including micropapillary-type STAS. Overall, DAEM offers a clinically actionable framework for STAS assessment by enabling accurate and interpretable detection on FSs and PSs, supporting postoperative risk stratification through quantitative TME-based analysis.

Liangrui Pan, Jiadi Luo, Yuxuan Xiao +13

College of Computer Science and Electronic Engineering, Hunan University, Changsha, 410082, China · Department of Pathology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China · Hunan Clinical Medical Research Center for Cancer Pathogenic Genes Testing and Diagnosis, Changsha, Hunan, 410011, China +8

Computational Pathology Oncology Explainable Medical Image Analysis Histopathology Image Classification Medical Image Localization

May 14, 2026cs.CV

Predicting Response to Neoadjuvant Chemotherapy in Ovarian Cancer from CT Baseline Using Multi-Loss Deep Learning

Ovarian cancer is the most lethal gynecologic malignancy: around 60% of patients are diagnosed at an advanced stage, with an associated 5-year survival rate of about 30%. Early identification of non-responders to neoadjuvant chemotherapy remains a key unmet need, as it could prevent ineffective therapy and avoid delays in optimal surgical management. This work proposes a non-invasive deep learning framework to predict neoadjuvant chemotherapy response from pre-treatment contrast-enhanced CT by leveraging automatically derived 3D lesion masks. The approach encodes axial slices with a partially fine-tuned pretrained image encoder and aggregates slice-level representations into a volumetric embedding through an attention-based module. Training combines classification loss with supervised contrastive regularization and hard-negative mining to improve separation between ambiguous responders and non-responders. The method was developed on a retrospective single-center cohort from the European Institute of Oncology (Milan, IT), including 280 eligible patients (147 responder, 133 non-responder). On the test cohort, the model achieved a ROC-AUC of 0.73 (95% CI: 0.58-0.86) and an F1-score of 0.70 (95% CI: 0.56-0.82). Overall, these results suggest that the proposed architecture learns clinically relevant predictive patterns and provides a robust foundation for an imaging-based stratification tool.

Francesco Pastori, Francesca Fati, Marina Rosanu +8

Department of Gynecologic Oncology, European Institute of Oncology, IEO, IRCCS, Milan, Italy · Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy · Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, USA +2

Clinical Outcome Prediction Oncology

May 13, 2026cs.CV

Learning to Optimize Radiotherapy Plans via Fluence Maps Diffusion Model Generation and LSTM-based Optimization

Volumetric Modulated Arc Therapy (VMAT) is a cornerstone of modern radiation therapy, enabling highly conformal tumor irradiation and healthy-tissue sparing. Yet, its planning solves inverse and nested optimization for multi-leaf collimators, monitor units and dose parameters, while enforcing their consistency to ensure mechanical deliverability. Nevertheless, this process often requires repeated re-optimization when treatment configurations change, resulting in substantial planning time per patient. To address these problems, we present a diffusion-driven Learning-to-Optimize (L2O) method for end-to-end VMAT planning. A distribution-matching distilled diffusion model learns a clinically feasible manifold of fluence maps, enabling their one-shot generation. On top of this, an LSTM-based L2O module learns gradient update dynamics to swiftly refine fluence maps toward prescribed dose objectives during inference. Experimental results on clinical and public prostate cancer cohorts demonstrate improved planning efficiency, flexibility, and machine deliverability over currently available end-to-end VMAT planners.

Isabella Poles, Simon Arberet, Riqiang Gao +5

Politecnico di Milano, Milan, Italy · Digital Technology and Innovation, Siemens Healthineers, Princeton, NJ, USA · Digital Technology and Innovation, Siemens Healthineers, Erlangen, Germany

Learning to Optimize Oncology Diffusion Models

May 13, 2026cs.LG

Uncertainty-Aware Prediction of Lung Tumor Growth from Sparse Longitudinal CT Data via Bayesian Physics-Informed Neural Networks

This work studies lung tumor growth prediction from sparse and irregular longitudinal computed tomography (CT) observations with measurement variability. A Bayesian physics-informed neural network is developed by combining Gompertz growth dynamics with low-dimensional Bayesian inference in the log-volume domain. The framework employs a two-stage inference strategy combining maximum a posteriori (MAP) estimation and Hamiltonian Monte Carlo (HMC) sampling to estimate posterior predictive distributions and uncertainty intervals. The method was evaluated on longitudinal data from the National Lung Screening Trial (30 patients). Results show that the model captures heterogeneous tumor growth patterns while maintaining reasonable prediction accuracy under limited observations. Compared with deterministic modeling approaches, the proposed approach additionally provides calibrated uncertainty estimates. The inferred posterior parameter correlations were consistent with expected biological growth behavior. The proposed framework achieved a cohort-level log-space RMSE of approximately 0.20 together with well-calibrated 95% credible interval coverage across 30 patients. These findings suggest that Bayesian physics-informed modeling may be useful for uncertainty-aware tumor growth assessment when only limited longitudinal follow-up scans are available.

Lingfei Kong, Haoran Ma

Department of Mathematics, Vanderbilt University, Nashville, TN, USA · John A. Paulson School of Engineering and Applied Science, Harvard University, Allston, MA, USA

Medical Image Analysis Longitudinal Medical Image Analysis Oncology Physics-Informed ML Uncertainty Calibration Regression Prediction Intervals

May 13, 2026cs.LG

Machine Learning-Driven Multimodal Spectroscopic Liquid Biopsy for Early Multicancer Detection

Cancer is one of the leading causes of death worldwide, making the development of rapid, minimally invasive, label-free and scalable diagnostic strategies a major challenge in modern oncology. In this context, spectroscopic liquid biopsy has emerged as a promising alternative, as it enables the holistic characterization of biochemical alterations in biological fluids. In this work, we propose a multimodal spectroscopic liquid biopsy framework for multicancer detection based on the combination of Fourier Transform Infrared (FTIR) spectroscopy, Raman spectroscopy, and Excitation-Emission Matrix (EEM) fluorescence spectroscopy together with Machine Learning (ML) methodologies. Serum samples from breast cancer patients, colorectal cancer patients, and healthy controls were analyzed through the three spectroscopic modalities. After modality-specific preprocessing, low-level data fusion (LLDF) was employed to integrate the complementary biochemical information encoded within the different spectroscopic measurements, and classification was performed using XGBoost models. Seven experimental configurations were evaluated, including the three unimodal approaches, all pairwise bimodal configurations, and the full multimodal approach of FTIR, Raman, and EEM fluorescence. The results show that although several individual modalities achieved high discrimination performance, the multimodal fusion provided the most balanced overall results, reaching a ROC-AUC of 0.997 for breast cancer and 0.994 for colorectal cancer, together with highly balanced sensitivity and specificity values.

Alejandro Leonardo García Navarro, Javier Cachón Ortiz, Javier González Colsa +2

Signal Processing Group Gregorio Marañón Health Research Institute Madrid, Spain · Amber Health Solutions Madrid, Spain

Multimodal Classification Oncology Multimodal Fusion

May 13, 2026cs.CV

Prediction of Rectal Cancer Regrowth from Longitudinal Endoscopy

Clinical trial studies indicate benefit of watch-and-wait (WW) surveillance for patients with rectal cancer showing a complete or near clinical response (CR) directly after treatment (restaging). However, there are no objectively accurate methods to early detect local tumor regrowth (LR) in patients undergoing WW from follow-up exams. Hence, we developed Temporal Rectal Endoscopy Cross-attention (TREX), a longitudinal deep learning approach that combines pairs of images acquired at restaging and follow-up to distinguish CR from LR. TREX uses pretrained Swin Transformers in a siamese setting to extract features from longitudinal images and dual cross-attention to combine the features without spatial co-registration between image pairs. TREX and Swin-based baselines were trained under two settings: (a) detecting LR or CR at the last available follow-up and (b) early detection of LR at 3--6, 6--12, and 12--24 months before clinical confirmation. TREX achieved the highest accuracy in detecting LR with a high sensitivity of 97%

\pm

6% and a balanced accuracy of 90%

\pm

3%, and outperformed all baselines in early detection at both 3--6 (74%

\pm

1%) and 6--12 months (62%

\pm

4%) prior to clinical detection. Clinical validation via a surgeon survey showed that TREX matched attending-level overall accuracy (TREX: 86.21% vs.\ Clinicians: 87.84%

\pm

1.28%). Finally, we explored TREX's ability to predict treatment response by combining pre-treatment (pre-TNT) and restaging endoscopies, achieving a balanced accuracy of 73%

\pm

12%. These results show that longitudinal deep learning analysis of endoscopy may improve surveillance and enable earlier identification of rectal cancer regrowth.

Jorge Tapias Gomez, Despoina Kanata, Aneesh Rangnekar +8

School of Computer Science, Cornell University and Cornell Tech, New York, NY · Department of Surgery, Colorectal Service, Memorial Sloan Kettering Cancer Center, New York, NY · Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY +3

Endoscopy Medical Image Analysis Longitudinal Medical Image Analysis Clinical Outcome Prediction Medical Image Classification Oncology

May 12, 2026q-bio.QM

Attention-Based Multimodal Survival Prediction with Cross-Modal Bilinear Fusion

We propose a novel multimodal deep learning framework for patient-level survival prediction, which integrates whole-slide histology features, RNA-seq expression profiles, and clinical variables. Our architecture combines an ABMIL module~\cite{ilse2018attention} for slide-level representation with feedforward encoders for RNA and clinical data. These embeddings are then integrated through low-rank bilinear cross-modal fusion~\cite{liu2018efficient} to model conditional interactions across modalities while controlling parameter growth. The model outputs continuous risk scores that are subsequently mapped to survival times using a nonparametric calibration procedure based on the Kaplan--Meier estimator~\cite{kaplan1958nonparametric}. By decomposing multimodal reasoning into independent pairwise interactions, the proposed fusion design promotes structural interpretability and parameter efficiency compared with full tensor and hierarchical fusion strategies. Experiments on the CHIMERA challenge dataset demonstrate improved predictive performance over concatenation-based baselines and competitive generalization on hidden evaluation cohorts. These results indicate that the proposed framework is a promising approach for multimodal survival prediction in HR-NMIBC. The implementation is publicly available at https://github.com/hassancpu/ChimeraChallenge2025_Task_3.

Hassan Keshvarikhojasteh, Josien P. W. Pluim, Mitko Veta

Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands

Representation Learning Cancer Survival Prediction Survival Analysis Oncology Multimodal Survival Analysis Multimodal Fusion

May 11, 2026cs.CV

RadThinking: A Dataset for Longitudinal Clinical Reasoning in Radiology

Cancer screening is a reasoning task. A radiologist observes findings, compares them to prior scans, integrates clinical context, and reaches a diagnostic conclusion confirmed by pathology. We present RadThinking, a Visual Question Answering (VQA) dataset that makes this reasoning explicit and trainable. RadThinking releases VQA pairs at three difficulty tiers. Foundation VQAs are atomic perception questions. Single-step reasoning VQAs apply one clinical rule. Compositional VQAs require multi-step chain-of-thought to reach a guideline category such as LI-RADS-5. For every compositional VQA, we release the chain of foundation VQAs that solves it. The chain follows the rules of the governing clinical reporting standard. The dataset spans 20,362 CT scans from 9,131 patients across 43 cancer groups, plus 2,077 verified healthy controls with >1-year follow-up. To our knowledge, RadThinking is the first cancer-screening VQA corpus that stratifies questions by reasoning depth and grounds compositions in clinical reporting standards. The foundation tier supplies atomic perception supervision. The compositional tier supplies chain-of-thought data and verifiable rewards for reinforcement-learning recipes such as DeepSeek-R1 and OpenAI o1. RadThinking enables systematic training and evaluation of whether AI systems can reason about cancer, not merely detect it.

Wenxuan Li, Pedro R. A. S. Bassi, Xinze Zhou +3

Department of Computer Science, Johns Hopkins University · Clinic of Radiology and Nuclear Medicine, University Hospital Basel · Department of Oncology, Johns Hopkins School of Medicine

Healthcare Medical VQA Clinical Reasoning Oncology Medical Image Benchmarks

May 11, 2026cs.LG

Predictive Radiomics for Evaluation of Cancer Immune SignaturE in Glioblastoma: the PRECISE-GBM study

Background: Radiogenomics allows identification of radiological biomarkers for genomic phenotypes. In glioblastoma, these biomarkers could potentially complement patient stratification strategies. We aim to develop and analytically validate radiological biomarkers that capture immune cell signatures within IDH-wildtype glioblastoma microenvironment using radiogenomic analysis. Methods: This was a retrospective multicenter study using curated open-access anonymized imaging and genomic data from TCGA-GBM, CPTAC, IvyGAP, REMBRANDT and CGGA datasets. Imaging data consisted of MRI-based radiomic features extracted from necrotic core, enhancing and edema regions of deep learning-based auto-segmented tumors. Radiomic feature selections were performed using nested cross-validated LASSO. Support vector machine and ensemble models were trained using seventeen immune and cell-specific score labels extracted from deconvoluted transcriptomic data using pan-cancer and glioblastoma immune signature matrices as reference standards. Seventeen classifier models trained in three cross-cohort strategies were validated on three held-out datasets assessing stability and generalizability. Results: One-hundred-and-seventy-six patients were included in the study. The immune-related radiomic signatures obtained after feature selection were shape, first order and higher order radiomic features. Models predicting macrophage subtype immune signature showed stable mean performance on balanced accuracy (0.67) and precision (0.89) metrics for three independent holdout datasets with ensemble model outperforming support vector machine model. Conclusion: Radiogenomic models non-invasively predicted the macrophage subtype M0 immune signature in IDH-wildtype glioblastoma. These biomarkers have the potential to stratify patients for immunotherapy within prospective glioblastoma clinical trials.

Prajwal Ghimire, Junjie Li, Liu Yaou +2

School of Biomedical Engineering & Imaging Sciences, King’s College London, UK · Department of Neurosurgery, King’s College Hospital, London, UK · Department of Neuroradiology, Beijing Tiantan Hospital, Beijing, China +1

Clinical Prediction Oncology Radiomics

May 8, 2026cs.CL

Can Language Models Identify Side Effects of Breast Cancer Radiation Treatments?

Accurately communicating the side effects of cancer treatments to cancer survivors is critical, particularly in settings such as informed consent, where clinicians must clearly and comprehensively convey potential treatment toxicities. However, this task remains challenging due to clinical knowledge deficits about adverse treatment effects and fragmentation across electronic health record (EHR) systems. Large language models (LLMs) have the potential to assist in this task, though their reliability in oncology survivorship contexts remains poorly understood. We present a deployment-oriented stress-testing framework for evaluating LLM-generated radiation side effect lists in breast cancer treatment and survivorship care. Using 21 breast cancer patient profiles, we construct paired patient clinical scenarios that differ only in radiotherapy regimens to evaluate seven instruction-tuned LLMs under multiple prompting regimes. We then compare LLM outputs to a clinician-curated reference derived from informed consent documents at two major academic medical centers and developed by a team including more than seven breast radiation oncologists. The reference maps radiation dose-fractionation, fields, and locations to associated toxicities, broken down by frequency and temporal onset. Across models, we reveal sensitivity to minor documentation changes, trade-offs between precision and recall, and systematic under-recall of rare and long-term side effects. When used alone, constraints on the number of side effects generated reduce precision, and grounding outputs in clinician-curated side effect lists substantially improves reliability and robustness. These findings highlight important limitations of LLM use in oncology and suggest practical design choices for safer and more informative survivorship-focused applications.

Natalie Seah, Danielle S. Bitterman, Daphna Spiegel +1

University of Virginia · Mass General Brigham, Dana-Farber Cancer Institute, Harvard Medical School

Breast Cancer Healthcare Oncology Clinical Language Model Evaluation Language Model Robustness Medical LLMs

May 8, 2026q-bio.MN

Graph neural network explanations reveal a topological signature of disease-associated hubs in biological networks

Graph neural networks (GNNs) are increasingly used to model biological systems, yet the reliability of post-hoc explanation methods for recovering meaningful molecular mechanisms remains unclear. Here, we systematically evaluate four widely used approaches: Saliency Attribution (SA), Integrated Gradients (IG), GNNExplainer, and Layer-wise Relevance Propagation (LRP) for identifying disease-relevant structure in breast cancer RNA-seq data projected onto a protein-protein interaction network. Using synthetic benchmarks with known ground-truth motifs, we show that explanation methods recover distinct signal organizations: SA performs best for sparse single-node drivers, whereas IG and LRP preferentially recover distributed pathway-like and cascade-like signals. In TCGA BRCA data, we identify a consistent topological signature of disease-associated hubs in which attribution peaks in the immediate 1-hop neighborhood and decays across successive network shells, a pattern most pronounced for IG and LRP and associated with strong enrichment of known cancer hubs. We further observe a trade-off between local hub enrichment and global gene ranking performance, with IG optimizing local enrichment and SA achieving superior global discrimination. Motivated by these complementary behaviors, we introduce a framework combining a shell-based hub score with consensus ranking across explainers. Consensus scores improve prioritization of canonical cancer genes (TP53, BRCA1, ESR1, MYC), reduce dependence on node degree, and, especially when tuned, outperform individual methods. Pathway enrichment further reveals improved recovery of biologically coherent cancer programs, including ERBB2, RTK, MAPK, immune, and cytokine signaling. Together, these results demonstrate that topology-aware integration of graph explanations can improve biological interpretability and biologically relevant molecular recovery.

Kyle Higgins, Ivan Laponogov, Dennis Veselkov +1

1Division of Cancer, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK. · Department of Computing, Imperial College London, U.K. · Department of Environmental Health Sciences, Yale University, New Haven, CT, USA.

Cancer Genomics Feature Attribution Oncology GNN Explainability

May 8, 2026q-bio.QM

PPI-Net connects molecular protein interactions to functional processes in disease

Understanding how molecular alterations propagate across biological systems to drive disease remains a central challenge. Although high-throughput profiling enables comprehensive characterization of tumor states, most models neglect structured biological relationships or lack interpretability across scales. Here we present PPI-Net, a hierarchical graph neural network that integrates protein-protein interaction (PPI) networks with pathway-level representations to model disease from molecular interactions to functional processes. Patient-specific molecular profiles are embedded within a shared interaction network from STRING and propagated through a multi-layer Reactome hierarchy using graph attention, enabling aggregation of gene-level signals into higher-order biological programs. Across RNA-seq data from ten cancer types from The Cancer Genome Atlas, PPI-Net achieves robust predictive performance, with balanced accuracy exceeding 90% in multiple cohorts. Comparative analysis on RNA-Seq data from breast cancer demonstrated that PPI-Net's integration of the Reactome hierarchy improved balanced accuracy by 6.7% relative to a PPI-only model, while hierarchical multi-level supervision improved balanced accuracy by 12.3% relative to using only a single top-level prediction head. Applying a multi-omics approach using RNA-seq and methylation data improves model interpretation, recovering canonical oncogenic modules, including TP53-AKT signaling and stress response pathways, while revealing convergence onto coherent programs such as ion signaling and cellular responses to stimuli. These results demonstrate that integrating interaction networks with pathway hierarchies enables accurate prediction while providing mechanistic insight into cancer biology.

Kyle Higgins, Guadalupe Gonzalez, Dennis Veselkov +2

Division of Cancer, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK. · Prescient Design, Genentech, South San Francisco, CA, USA. · Department of Computing, Imperial College London, U.K.

Cancer Genomics Graph Neural Networks Hierarchical Representation Learning Oncology

May 8, 2026cs.CV

Multimodal Stepwise Clinically-Guided Attention Learning for Pathological Complete Response Prediction in Breast Cancer

Pathological complete response (pCR) is a key prognostic factor in breast cancer patients undergoing neoadjuvant therapy, strongly associated with long-term survival and treatment personalization. However, accurate pre-treatment pCR prediction remains challenging due to severe class imbalance and limited generalizability across diverse clinical settings. In this work, we propose a multimodal stepwise clinically-guided attention learning framework for pCR prediction from breast magnetic resonance imaging (MRI), designed to address these limitations through medically grounded spatial guidance and multimodal integration. The approach follows a stepwise training strategy inspired by physician reasoning: the model first learns global discriminative imaging patterns, then attention mechanisms are introduced to constrain the network toward tumor regions, and finally clinical variables are integrated to refine decision-making. This guidance strategy encourages prioritization of task-relevant features, improving identification of responders despite their limited representation in the dataset. Moreover, grounding attention in anatomically consistent tumor regions reduces reliance on dataset-specific patterns, thereby enhancing cross-institutional generalization. The framework is evaluated through external validation across heterogeneous MRI cohorts. Compared to non-guided single-stage baselines, the proposed approach improves sensitivity while maintaining competitive specificity, and produces anatomically coherent attention maps that support interpretation of the model's predictions. These findings highlight the potential of clinically-guided multimodal attention learning for robust and generalizable pCR prediction in breast cancer.

Alice Natalina Caragliano, Valerio Guarrasi, Michela Gravina +2

Unit of Artificial Intelligence and Computer Systems, Department of Engineering, Università Campus Bio-Medico di Roma, Rome, Italy · Department of Electrical Engineering and Information Technology, University of Naples Federico II, Naples, Italy · Department of Diagnostics and Intervention, Radiation Physics, Biomedical Engineering, Umeå University, Umeå, Sweden

Breast Cancer Clinical Outcome Prediction Multimodal Classification Oncology Explainable Medical Image Analysis

May 7, 2026physics.med-ph

Overcoming data scarcity through multi-center federated learning for organs-at-risk segmentation in pediatric upper abdominal radiotherapy

Deep learning-based organs/structures-at-risk(OARs) auto-contouring models can improve radiotherapy workflows, but models trained on adult data often underperform in pediatric patients. Developing robust pediatric-specific models is hindered by data scarcity and fragmentation across centers. Federated learning (FL) enables privacy-preserving collaborative training without the need for data sharing. We evaluated the feasibility and performance of FL for developing pediatric-specific OAR segmentation models across two European medical centers. Computed tomography (CT) images from pediatric patients from Utrecht and Heidelberg with a renal tumor or abdominal neuroblastoma were retrospectively collected and locally processed. An nnU-Net-based framework segmented 19 OARs using local and FL schemes. FL was implemented with secure weight exchange on a cloud storage across institutional firewalls. Performance was assessed using the Dice similarity coefficient (DSC), 95th percentile Hausdorff distance, and mean surface distance. Robustness to patient orientation, false-positive segmentation of surgically removed kidneys, and failure cases were identified. A total of 310 postoperative CTs from 272 patients (105 renal tumors, 167 neuroblastomas) were included. Local models performed well on their respective center data but showed significantly reduced cross-center performance for four to seven of the nine evaluated OARs (DSC). In contrast, the FL model matched local performance for at least seven of nine OARs and achieved the best cross-center results across three metrics, with DSC gains of 0.003-0.007 over local models. FL also maintained stable performance across patient orientations and reduced false-positive kidney segmentations. Real-world FL improves cross-center robustness of CT-based OAR segmentation models in pediatric upper abdominal tumors.

Mianyong Ding, Maximilian Knoll, Semi Harrabi +7

Department of Radiation Oncology, Imaging and Cancer Division, University Medical Centre Utrecht, Utrecht, The Netherlands · University Hospital Heidelberg, Heidelberg Ion Beam Therapy Centre (HIT), Department of Radiation Oncology, Heidelberg, Germany · Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands +3

Medical Image Segmentation Oncology Federated Learning

May 6, 2026stat.ML

Forecasting Oncology Demand Trends with Boosting-Based Bayesian Conjugate Models

Accurate trend forecasting in healthcare time series is essential for planning and resource allocation. This paper proposes a Bayesian framework for predicting oncology demand trends, modeling weekly appointments as a Poisson process with a Gamma prior to the demand rate. To enhance adaptability and capture persistent directional patterns, we incorporate a residual-based boosting mechanism grounded in a Gamma-Log-Normal conjugate structure. This boosting approach allows the model to track both short- and long-term trend shifts while maintaining the analytical tractability of conjugate Bayesian updating. The methodology was evaluated on real oncology service data from Cariri, Ceara, Brazil, and compared against established baselines, including linear regression, ARIMA, naive forecasting, LSTM neural networks, and XGBoost. Results showed that the proposed model outperforms competing methods in trend detection accuracy, with gains in terms of percentage of correct direction of 38.25% in relation to the second best approach in some cases.

Ademir Batista dos Santos Neto, Tiago Alessandro Espinola Ferreira, Paulo Renato Alves Firmino

Bayesian Inference Time Series Forecasting Oncology Probabilistic Time Series Forecasting

May 6, 2026cs.CV

A Breast Vision Pathology Foundation Model for Real-world Clinical Utility

Pathology foundation models have shown strong retrospective performance, but whether such systems can support clinically relevant use remains unclear. This challenge is particularly important in breast cancer, where pathological assessment serves as the gold standard for diagnosis and guides treatment planning, surgical decision-making and risk stratification across pre-, intra- and post-operative stages. Here we present \textbf{BRAVE}, a breast-adaptive pathology foundation model developed and evaluated using a total resource of 101,638 breast whole-slide images from 32 sources across Asia, Europe and North America. We assessed BRAVE across 34 tasks in 82 cohorts spanning pre-operative biopsy, intra-operative frozen section and post-operative resection, using an evidence chain comprising retrospective benchmarking, clinically challenging scenarios, workflow-oriented clinical impact simulations, prospective observational validation with the thresholds locked in the retrospective cohorts and crossover pathologist-AI interaction studies. Across these settings, BRAVE supported practical roles in the clinical workflow, including safe exclusion of low-risk cases from routine review, AI-assisted second-review rescue of initially missed positives and prioritization of cases for further assessment. In prospective validation across three centres, BRAVE excluded 76.9% of negative biopsy cases (NPV 0.953) and 70.1% of negative frozen-section cases (NPV 0.973), and triaged 78.8% of post-operative subtyping cases as high-confidence clear-cut cases (NPV 1.000). In reader studies, AI assistance improved balanced accuracy from 88.5% to 95.1% (OR 3.14, P<0.001), with better efficiency, confidence and inter-rater agreement. BRAVE-derived scores also independently predicted disease-free survival (adjusted HR 4.79, P<0.001) and overall survival (adjusted HR 8.14, P<0.001).

Yingxue Xu, Zhengyu Zhang, Xiuming Zhang +32

Department of Computer Science and Engineering, The Hong Kong University of Science and Technology, Hong Kong SAR, China · Department of Pathology, Nanfang Hospital, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China · Department of Pathology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China +18

Healthcare Clinical Decision Support Pathology Foundation Models Oncology Histopathology Image Classification Whole-Slide Image Analysis

May 5, 2026cs.CL

Atomic Fact-Checking Increases Clinician Trust in Large Language Model Recommendations for Oncology Decision Support: A Randomized Controlled Trial

Question: Does atomic fact-checking, which decomposes AI treatment recommendations into individually verifiable claims linked to source guideline documents, increase clinician trust compared to traditional explainability approaches? Findings: In this randomized trial of 356 clinicians generating 7,476 trust ratings, atomic fact-checking produced a large effect on trust (Cohen's d = 0.94), increasing the proportion of clinicians expressing trust from 26.9% to 66.5%. Traditional transparency mechanisms showed a dose-response gradient of improvement over baseline (d = 0.25 to 0.50). Meaning: Decomposing AI recommendations into individually verifiable claims linked to source guidelines produces substantially higher clinician trust than traditional explainability approaches in high-stakes clinical decisions.

Lisa C. Adams, Linus Marx, Erik Thiele Orberg +8

Department of Diagnostic and Interventional Radiology, TUM University Hospital Rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany · Department of Radiation Oncology, TUM University Hospital Rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany · Department of Internal Medicine III: Hematology and Clinical Oncology, University Hospital Regensburg, University of Regensburg, Regensburg, Germany +4

Healthcare Clinical Decision Support Automated Fact-Checking Oncology Trust in AI Clinical Language Model Evaluation+1

May 4, 2026eess.IV

Biological Spatial Priors Regularize Foundation Model Representations for Cross-Site MSI Generalization in Colorectal Cancer

Predicting microsatellite instability (MSI) status from routine hematoxylin and eosin (H&E) whole slide images (WSIs) offers a practical alternative to molecular testing, but models trained at one institution tend to generalize poorly to slides acquired at a different site. Foundation model representations, despite their generality, still encode site-specific texture alongside the conserved biological morphology underlying MSI. We investigate whether tile-level spatial priors derived from known MSI histology can guide these representations toward more site-invariant features. We introduce a biologically motivated spatial prior based on peripheral distance encoding, reflecting the Crohn's-like peripheral lymphocytic reaction at the tumor invasive margin, and evaluate a secondary local immune neighborhood encoding reflecting the lymphocyte-to-tumor ratio in each tile's immediate spatial neighborhood. Both priors are injected into a TransMIL aggregator before self-attention, allowing the transformer to integrate spatial biological context with UNI2-h or Virchow2 features across all attention layers. We evaluate six foundation model and MIL aggregator combinations as a reference, then assess the effect of each spatial prior. Training on TCGA-COAD (137 slides) and evaluating externally on TCGA-READ (50 slides) without retraining, peripheral distance encoding achieves MSI AUC 0.959 +/- 0.012 on COAD and MSS specificity 1.000 on READ, compared to 0.957 and 0.939 for the strongest reference configuration. Local immune neighborhood encoding achieves comparable internal AUC but lower cross-site specificity, suggesting margin proximity encodes a more site-invariant biological signal than local immune density. Results suggest biologically grounded spatial priors act as regularizers that reduce reliance on site-specific imaging patterns.

Dasari Naga Raju

Spatial Generalization Pathology Foundation Models Clinical Prediction Oncology Histopathology Image Classification

May 4, 2026cs.CV

Validation of an AI-based end-to-end model for prostate pathology using long-term archived routine samples

Artificial intelligence (AI) is becoming a clinical tool for prostate pathology, but generalization across variations in sample preparation and preservation over prolonged time periods remains poorly understood. We evaluated GleasonAI, an end-to-end attention-based multiple instance learning model, on an independent validation cohort comprising 10,366 biopsy cores from 1,028 patients across 14 Swedish regions, using archival diagnostic specimens from the ProMort cohorts collected between 1998-2015. The model achieved an overall quadratic-weighted kappa of 0.86 for core-level ISUP grading, comparable to several experienced pathologists and consistent across geographic regions. Notably, performance remained stable across the 17-year collection period, demonstrating robustness to time-related variation in archival material, a property not consistently observed with foundation model-based approaches, with exploratory analysis demonstrating a significant prognostic gradient across AI-assigned grade groups for prostate cancer-specific mortality. These findings support the generalizability of the AI grading model and demonstrate the potential of pathology archives as a large-scale resource for AI development, validation, and retrospective prognostic research.

Xiaoyi Ji, Renata Zelic, Oskar Aspegren +11

Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden · Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden · Department of Pelvic Cancer, Cancer Theme, Karolinska University Hospital, Stockholm, Sweden +8

Computational Pathology Domain Generalization Oncology Histopathology Image Classification Cross-Dataset Generalization

May 4, 2026cs.LG

Recurrent Deep Reinforcement Learning for Chemotherapy Control under Partial Observability

Chemotherapy dose optimization can be formulated as a dynamic treatment regime, requiring sequential decisions under uncertainty that must balance tumor suppression against toxicity. However, most reinforcement learning approaches assume full observability of the patient state, a condition rarely met in clinical practice. We investigate whether memory-augmented policies can improve chemotherapy control under partial observability. To this end, we employ a recurrent TD3-based approach with separate LSTM actor-critic networks and evaluate it on the AhnChemoEnv benchmark from DTR-Bench, considering both off-policy and on-policy recurrent architectures against feed-forward TD3 and Soft Actor-Critic. Pharmacokinetic and pharmacodynamic variability are held fixed to isolate hidden-state uncertainty and observation noise and to avoid confounding effects from inter-patient variability. Across ten random seeds, recurrence yields modest benefit under full observability but substantially stronger and more stable performance under partial observability, with more consistent tumor suppression and improved normal-cell preservation. These findings indicate that memory-based policies are particularly beneficial when clinically relevant state information is incomplete or noisy.

Firas Mohamed Elamine Kiram, Imane Youkana, Rachida Saouli +2

Dept. of Information Engineering University of Padova Padova, Italy · LINFI Lab, Dept. of Computer Science University of Biskra Biskra, Algeria

Reinforcement Learning Healthcare Sequential Decision Making Partially Observable RL Oncology

May 2, 2026cs.CV

Exploring Prompt Alignment with Clinical Factors in Zero-Shot Segmentation VLMs for NSCLC Tumor Segmentation

Zero-shot vision-language models (VLMs) offer a promptable alternative to task-specific training for gross tumor volume (GTV) delineation in non-small-cell lung cancer (NSCLC), but the prompt dimensions that govern their spatial behavior remain poorly understood. We study this question by probing alignment directions in VoxTell on a held-out internal NSCLC tumor dataset through sub-prompt decomposition into diagnosis, demographic, staging, anatomical, generic, and irrelevant controls; attribute-wise perturbation robustness; specificity ladders; and cross-case prompt swaps, while benchmarking against fine-tuned and zero-shot baselines using the Dice Similarity Coefficient (DSC) with Wilcoxon signed-rank tests and Benjamini-Hochberg correction. Alignment analyses revealed that anatomical location is the dominant driver of VoxTell's spatial attention: 63.4 percent of location perturbations caused catastrophic drops, prompt specificity improved from generic to full descriptions except for diagnosis-only prompts, irrelevant prompts correctly yielded zero segmentation, and cross-case prompt swaps confirmed patient-specific conditioning (matched DSC 0.906 vs. mismatched 0.406). Histology and stage substitutions had minimal effect, indicating that the model prioritizes "where to look" over "what to look for." In this context, VoxTell, operating fully zero-shot, achieved a mean DSC of 0.613, statistically indistinguishable from nnUNet (0.690, adjusted p = 0.156) and Ahmed et al. (0.675, adjusted p = 0.679), while significantly outperforming all other zero-shot models. Together, these findings argue that segmentation VLMs should be evaluated not only by Dice, but also by the prompt dimensions to which they align.

Suraj Pai, Thibault Heintz, Cosmin Ciausu +3

Artificial Intelligence in Medicine Program, Mass General Brigham, Harvard Medical School, USA

VLM Robustness Image Segmentation Medical VLMs Medical Image Segmentation Oncology Zero-Shot Medical Image Segmentation