Daily Papers

Differential diagnosis is crucial for medicine as it helps healthcare providers systematically distinguish between conditions that share similar symptoms. This study assesses the impact of lab test results on differential diagnoses (DDx) made by large language models (LLMs). Clinical vignettes from 50 case reports from PubMed Central were created incorporating patient demographics, symptoms, and lab results. Five LLMs GPT-4, GPT-3.5, Llama-2-70b, Claude-2, and Mixtral-8x7B were tested to generate Top 10, Top 5, and Top 1 DDx with and without lab data. A comprehensive evaluation involving GPT-4, a knowledge graph, and clinicians was conducted. GPT-4 performed best, achieving 55% accuracy for Top 1 diagnoses and 60% for Top 10 with lab data, with lenient accuracy up to 80%. Lab results significantly improved accuracy, with GPT-4 and Mixtral excelling, though exact match rates were low. Lab tests, including liver function, metabolic/toxicology panels, and serology/immune tests, were generally interpreted correctly by LLMs for differential diagnosis.

The emergence of groundbreaking large language models capable of performing complex reasoning tasks holds significant promise for addressing various scientific challenges, including those arising in complex clinical scenarios. To enable their safe and effective deployment in real-world healthcare settings, it is urgently necessary to benchmark the diagnostic capabilities of current models systematically. Given the limitations of existing medical benchmarks in evaluating advanced diagnostic reasoning, we present DiagnosisArena, a comprehensive and challenging benchmark designed to rigorously assess professional-level diagnostic competence. DiagnosisArena consists of 1,113 pairs of segmented patient cases and corresponding diagnoses, spanning 28 medical specialties, deriving from clinical case reports published in 10 top-tier medical journals. The benchmark is developed through a meticulous construction pipeline, involving multiple rounds of screening and review by both AI systems and human experts, with thorough checks conducted to prevent data leakage. Our study reveals that even the most advanced reasoning models, o3-mini, o1, and DeepSeek-R1, achieve only 45.82%, 31.09%, and 17.79% accuracy, respectively. This finding highlights a significant generalization bottleneck in current large language models when faced with clinical diagnostic reasoning challenges. Through DiagnosisArena, we aim to drive further advancements in AIs diagnostic reasoning capabilities, enabling more effective solutions for real-world clinical diagnostic challenges. We provide the benchmark and evaluation tools for further research and development https://github.com/SPIRAL-MED/DiagnosisArena.

Skin conditions affect an estimated 1.9 billion people worldwide. A shortage of dermatologists causes long wait times and leads patients to seek dermatologic care from general practitioners. However, the diagnostic accuracy of general practitioners has been reported to be only 0.24-0.70 (compared to 0.77-0.96 for dermatologists), resulting in referral errors, delays in care, and errors in diagnosis and treatment. In this paper, we developed a deep learning system (DLS) to provide a differential diagnosis of skin conditions for clinical cases (skin photographs and associated medical histories). The DLS distinguishes between 26 skin conditions that represent roughly 80% of the volume of skin conditions seen in primary care. The DLS was developed and validated using de-identified cases from a teledermatology practice serving 17 clinical sites via a temporal split: the first 14,021 cases for development and the last 3,756 cases for validation. On the validation set, where a panel of three board-certified dermatologists defined the reference standard for every case, the DLS achieved 0.71 and 0.93 top-1 and top-3 accuracies respectively. For a random subset of the validation set (n=963 cases), 18 clinicians reviewed the cases for comparison. On this subset, the DLS achieved a 0.67 top-1 accuracy, non-inferior to board-certified dermatologists (0.63, p<0.001), and higher than primary care physicians (PCPs, 0.45) and nurse practitioners (NPs, 0.41). The top-3 accuracy showed a similar trend: 0.90 DLS, 0.75 dermatologists, 0.60 PCPs, and 0.55 NPs. These results highlight the potential of the DLS to augment general practitioners to accurately diagnose skin conditions by suggesting differential diagnoses that may not have been considered. Future work will be needed to prospectively assess the clinical impact of using this tool in actual clinical workflows.

General-purpose Large Vision-Language Models (LVLMs), despite their massive scale, often falter in dermatology due to "diffuse attention" - the inability to disentangle subtle pathological lesions from background noise. In this paper, we challenge the assumption that parameter scaling is the only path to medical precision. We introduce SkinFlow, a framework that treats diagnosis as an optimization of visual information transmission efficiency. Our approach utilizes a Virtual-Width Dynamic Vision Encoder (DVE) to "unfold" complex pathological manifolds without physical parameter expansion, coupled with a two-stage Reinforcement Learning strategy. This strategy sequentially aligns explicit medical descriptions (Stage I) and reconstructs implicit diagnostic textures (Stage II) within a constrained semantic space. Furthermore, we propose a clinically grounded evaluation protocol that prioritizes diagnostic safety and hierarchical relevance over rigid label matching. Empirical results are compelling: our 7B model establishes a new state-of-the-art on the Fitzpatrick17k benchmark, achieving a +12.06% gain in Top-1 accuracy and a +28.57% boost in Top-6 accuracy over the massive general-purpose models (e.g., Qwen3VL-235B and GPT-5.2). These findings demonstrate that optimizing geometric capacity and information flow yields superior diagnostic reasoning compared to raw parameter scaling.

Rare diseases collectively affect an estimated 3.5% to 5.9% of the population, yet more than 70% of patients are misdiagnosed and many endure years of evaluation before a diagnosis is reached, because early presentations are nonspecific and relevant expertise is scarce and unevenly distributed. Artificial intelligence could provide support, but existing systems address isolated stages of care, overwhelmingly diagnosis. They typically depend on the results of downstream investigations, and they treat the variability between models as noise to be eliminated. Here we present RareLens, a system that supports clinical decision-making across the entire rare disease trajectory by exploiting this variability. When heterogeneous large language models evaluate the same case, they generate divergent but complementary reasoning, which RareLens aligns and calibrates into a single convergent, actionable decision at each stage. Four coordinated modules perform primary-visit risk screening, diagnosis, treatment planning and prognosis. Developed and evaluated on RareBench, a real-world dataset of 157,525 cases spanning all 33 Orphanet categories and more than 7,000 conditions, RareLens outperformed every frontier model tested, including GPT-5, DeepSeek-R1, Claude-3.7-Sonnet and Gemini-2.5-Pro, at each stage. It achieved an area under the curve of 0.917 for screening and top-1 accuracies of 65.5% and 89.8% for diagnosis and treatment. In an external study spanning 1,287 cases and 23 physicians, autonomous RareLens and physicians assisted by RareLens both substantially outperformed unaided physicians. These findings indicate that aligning divergent model reasoning, rather than scaling a single model, offers a generalizable strategy for high-uncertainty clinical decision-making.

CI failure logs are large (median 5k lines, max 200k in this corpus) and noisy. Coding agents that try to debug them depend on an upstream tool to reduce the log to a manageable context, but the field has had no public empirical comparison of which reductions preserve enough evidence for downstream LLM diagnosis. We introduce LogDx-CI, a benchmark that compares 11 context-reduction tools (raw, tail, grep, three RTK modes, two real LLM map-reduce summarizers, three hybrid routers) on 35 real GitHub Actions failure cases, scored by 3 LLM debugger families (Claude Haiku 4.5, Claude Sonnet 4.6, OpenAI gpt-5-mini) plus a Sonnet 4.6 tool-using agent. We report three load-bearing findings. (1)~Hybrid grep+tail routers dominate the cost-quality Pareto frontier; the top two methods score 0.670 / 0.666 at sim \0.03 per case, same-ballpark quality as standalone grep at 4.5\times fewer tokens. (2)~In the agent-loop regime, the quality range across reduction tools collapses 7\times (single-shot spread 0.42 \to agent-loop spread 0.059); the agent rescues weak contexts via follow-up tool calls. However, cost differences persist: weak contexts force the agent to issue 2--4\times more tool calls to recover. (3)~A cross-family LLM-summary pair (gpt-5-mini summarizer feeding a Claude Haiku debugger) beats the same-family pair by +0.071 averaged across four diagnoser variants, falsifying the self-call-bias hypothesis on this task. The gpt-5-mini summarizer is also the agent-loop #1 method (score 0.749) at 0.37 tool-calls per case and 10\times lower reducer cost than the Haiku summarizer (0.18 vs \$1.75 per case). All data, code, per-case bundles, and reproducibility infrastructure are public.

Vector search and retrieval-augmented generation (RAG) rest on the assumption that cosine similarity between text embeddings reflects conceptual relatedness. We measure where this assumption breaks. We build an augmented citation graph over 3.58M scientific papers and partition it via Leiden CPM at two granularities: sub-field (L1) and research-agenda (L2, hierarchical inside each L1). Four state-of-the-art embeddings (Gemini, Qwen3-8B, Qwen3-0.6B, SPECTER2) clear the L1 bar reasonably (45-52% top-10 same-rate) but stop working at L2: only 15-21% of top-10 neighbors share the query's research agenda. In absolute terms, 8 of every 10 retrieved papers are off-agenda. The failure is universal across eight scientific domains and all four models; SPECTER2, despite its citation-based contrastive training, is the weakest. As a diagnostic probe, we test whether the same augmented graph also functions as a retrieval signal: a deliberately simple citation-count rerank reaches 57.7% top-1 L2 on top of LLM-expanded Boolean retrieval and 59.6% on top of plain BM25, on 80 curated agenda queries -- about 9 points above the best cosine retriever (Gemini, 50.6%) and 20 points above BM25 alone (39.3%). The probe isolates a slice of the agenda-matching signal the graph carries but the embeddings miss, connecting recent theoretical limits on single-vector retrieval to a concrete failure mode of scientific RAG.

Artificial Intelligence (AI) conferences are essential for advancing research, sharing knowledge, and fostering academic community. However, their rapid expansion has rendered the centralized conference model increasingly unsustainable. This paper offers a data-driven diagnosis of a structural crisis that threatens the foundational goals of scientific dissemination, equity, and community well-being. We identify four key areas of strain: (1) scientifically, with per-author publication rates more than doubling over the past decade to over 4.5 papers annually; (2) environmentally, with the carbon footprint of a single conference exceeding the daily emissions of its host city; (3) psychologically, with 71% of online community discourse reflecting negative sentiment and 35% referencing mental health concerns; and (4) logistically, with attendance at top conferences such as NeurIPS 2024 beginning to outpace venue capacity. These pressures point to a system that is misaligned with its core mission. In response, we propose the Community-Federated Conference (CFC) model, which separates peer review, presentation, and networking into globally coordinated but locally organized components, offering a more sustainable, inclusive, and resilient path forward for AI research.

Clinical diagnosis is critical in medical practice, typically requiring a continuous and evolving process that includes primary diagnosis, differential diagnosis, and final diagnosis. However, most existing clinical diagnostic tasks are single-step processes, which does not align with the complex multi-step diagnostic procedures found in real-world clinical settings. In this paper, we propose a multi-step diagnostic task and annotate a clinical diagnostic dataset (MSDiagnosis). This dataset includes primary diagnosis, differential diagnosis, and final diagnosis questions. Additionally, we propose a novel and effective framework. This framework combines forward inference, backward inference, reflection, and refinement, enabling the LLM to self-evaluate and adjust its diagnostic results. To assess the effectiveness of our proposed method, we design and conduct extensive experiments. The experimental results demonstrate the effectiveness of the proposed method. We also provide a comprehensive experimental analysis and suggest future research directions for this task.

Large language models (LLMs) offer a promising pre-screening tool, improving early disease detection and providing enhanced healthcare access for underprivileged communities. The early diagnosis of various diseases continues to be a significant challenge in healthcare, primarily due to the nonspecific nature of early symptoms, the shortage of expert medical practitioners, and the need for prolonged clinical evaluations, all of which can delay treatment and adversely affect patient outcomes. With impressive accuracy in prediction across a range of diseases, LLMs have the potential to revolutionize clinical pre-screening and decision-making for various medical conditions. In this work, we study the diagnostic capability of LLMs for Rheumatoid Arthritis (RA) with real world patients data. Patient data was collected alongside diagnoses from medical experts, and the performance of LLMs was evaluated in comparison to expert diagnoses for RA disease prediction. We notice an interesting pattern in disease diagnosis and find an unexpected misalignment between prediction and explanation. We conduct a series of multi-round analyses using different LLM agents. The best-performing model accurately predicts rheumatoid arthritis (RA) diseases approximately 95\% of the time. However, when medical experts evaluated the reasoning generated by the model, they found that nearly 68\% of the reasoning was incorrect. This study highlights a clear misalignment between LLMs high prediction accuracy and its flawed reasoning, raising important questions about relying on LLM explanations in clinical settings. LLMs provide incorrect reasoning to arrive at the correct answer for RA disease diagnosis.