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Add to EdgeLRMR: LLM-Driven Relational Multi-node Ranking for Lymph Node Metastasis Assessment in Rectal Cancer
Jul 15, 2025
Accurate preoperative assessment of lymph node (LN) metastasis in rectal cancer guides treatment decisions, yet conventional MRI evaluation based on morphological criteria shows limited diagnostic performance. While some artificial intelligence models have been developed, they often operate as black boxes, lacking the interpretability needed for clinical trust. Moreover, these models typically evaluate nodes in isolation, overlooking the patient-level context. To address these limitations, we introduce LRMR, an LLM-Driven Relational Multi-node Ranking framework. This approach reframes the diagnostic task from a direct classification problem into a structured reasoning and ranking process. The LRMR framework operates in two stages. First, a multimodal large language model (LLM) analyzes a composite montage image of all LNs from a patient, generating a structured report that details ten distinct radiological features. Second, a text-based LLM performs pairwise comparisons of these reports between different patients, establishing a relative risk ranking based on the severity and number of adverse features. We evaluated our method on a retrospective cohort of 117 rectal cancer patients. LRMR achieved an area under the curve (AUC) of 0.7917 and an F1-score of 0.7200, outperforming a range of deep learning baselines, including ResNet50 (AUC 0.7708). Ablation studies confirmed the value of our two main contributions: removing the relational ranking stage or the structured prompting stage led to a significant performance drop, with AUCs falling to 0.6875 and 0.6458, respectively. Our work demonstrates that decoupling visual perception from cognitive reasoning through a two-stage LLM framework offers a powerful, interpretable, and effective new paradigm for assessing lymph node metastasis in rectal cancer.
WeGA: Weakly-Supervised Global-Local Affinity Learning Framework for Lymph Node Metastasis Prediction in Rectal Cancer
May 15, 2025Accurate lymph node metastasis (LNM) assessment in rectal cancer is essential for treatment planning, yet current MRI-based evaluation shows unsatisfactory accuracy, leading to suboptimal clinical decisions. Developing automated systems also faces significant obstacles, primarily the lack of node-level annotations. Previous methods treat lymph nodes as isolated entities rather than as an interconnected system, overlooking valuable spatial and contextual information. To solve this problem, we present WeGA, a novel weakly-supervised global-local affinity learning framework that addresses these challenges through three key innovations: 1) a dual-branch architecture with DINOv2 backbone for global context and residual encoder for local node details; 2) a global-local affinity extractor that aligns features across scales through cross-attention fusion; and 3) a regional affinity loss that enforces structural coherence between classification maps and anatomical regions. Experiments across one internal and two external test centers demonstrate that WeGA outperforms existing methods, achieving AUCs of 0.750, 0.822, and 0.802 respectively. By effectively modeling the relationships between individual lymph nodes and their collective context, WeGA provides a more accurate and generalizable approach for lymph node metastasis prediction, potentially enhancing diagnostic precision and treatment selection for rectal cancer patients.