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Main Authors: Gondara, Lovedeep, Simkin, Jonathan, Devji, Shebnum, Arbour, Gregory, Ng, Raymond
Format: Preprint
Published: 2025
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Online Access:https://arxiv.org/abs/2503.21800
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author Gondara, Lovedeep
Simkin, Jonathan
Devji, Shebnum
Arbour, Gregory
Ng, Raymond
author_facet Gondara, Lovedeep
Simkin, Jonathan
Devji, Shebnum
Arbour, Gregory
Ng, Raymond
contents Background: Population-based cancer registries (PBCRs) manually extract data from unstructured pathology reports, a labor-intensive process where assigning reports to tumor groups can consume 900 person-hours annually for approximately 100,000 reports at a medium-sized registry. Current automated rule-based systems fail to handle the linguistic complexity of this classification task. Materials and Methods: We present ELM (Ensemble of Language Models), a novel hybrid approach combining small, encoder only language models and large language models (LLMs). ELM employs an ensemble of six fine-tuned encoder only models: three analyzing the top portion and three analyzing the bottom portion of each report to maximize text coverage given token limits. A tumor group is assigned when at least five of six models agree; otherwise, an LLM arbitrates using a carefully curated prompt constrained to likely tumor groups. Results: On a held-out test set of 2,058 pathology reports spanning 19 tumor groups, ELM achieves weighted precision and recall of 0.94, representing a statistically significant improvement (p<0.001) over encoder-only ensembles (0.91 F1-score) and substantially outperforming rule-based approaches. ELM demonstrates particular gains for challenging categories including leukemia (F1: 0.76 to 0.88), lymphoma (0.76 to 0.89), and skin cancer (0.44 to 0.58). Discussion: Deployed in production at British Columbia Cancer Registry, ELM has reduced manual review requirements by approximately 60-70%, saving an estimated 900 person-hours annually while maintaining data quality standards. Conclusion: ELM represents the first successful deployment of a hybrid small, encoder only models-LLM architecture for tumor group classification in a real-world PBCR setting, demonstrating how strategic combination of language models can achieve both high accuracy and operational efficiency.
format Preprint
id arxiv_https___arxiv_org_abs_2503_21800
institution arXiv
publishDate 2025
record_format arxiv
spellingShingle ELM: A Hybrid Ensemble of Language Models for Automated Tumor Group Classification in Population-Based Cancer Registries
Gondara, Lovedeep
Simkin, Jonathan
Devji, Shebnum
Arbour, Gregory
Ng, Raymond
Computation and Language
Artificial Intelligence
Machine Learning
Background: Population-based cancer registries (PBCRs) manually extract data from unstructured pathology reports, a labor-intensive process where assigning reports to tumor groups can consume 900 person-hours annually for approximately 100,000 reports at a medium-sized registry. Current automated rule-based systems fail to handle the linguistic complexity of this classification task. Materials and Methods: We present ELM (Ensemble of Language Models), a novel hybrid approach combining small, encoder only language models and large language models (LLMs). ELM employs an ensemble of six fine-tuned encoder only models: three analyzing the top portion and three analyzing the bottom portion of each report to maximize text coverage given token limits. A tumor group is assigned when at least five of six models agree; otherwise, an LLM arbitrates using a carefully curated prompt constrained to likely tumor groups. Results: On a held-out test set of 2,058 pathology reports spanning 19 tumor groups, ELM achieves weighted precision and recall of 0.94, representing a statistically significant improvement (p<0.001) over encoder-only ensembles (0.91 F1-score) and substantially outperforming rule-based approaches. ELM demonstrates particular gains for challenging categories including leukemia (F1: 0.76 to 0.88), lymphoma (0.76 to 0.89), and skin cancer (0.44 to 0.58). Discussion: Deployed in production at British Columbia Cancer Registry, ELM has reduced manual review requirements by approximately 60-70%, saving an estimated 900 person-hours annually while maintaining data quality standards. Conclusion: ELM represents the first successful deployment of a hybrid small, encoder only models-LLM architecture for tumor group classification in a real-world PBCR setting, demonstrating how strategic combination of language models can achieve both high accuracy and operational efficiency.
title ELM: A Hybrid Ensemble of Language Models for Automated Tumor Group Classification in Population-Based Cancer Registries
topic Computation and Language
Artificial Intelligence
Machine Learning
url https://arxiv.org/abs/2503.21800