NDLI: MISTIC: a novel approach for metastasis classification in Italian electronic health records using transformers

Content Provider	Springer Nature : BioMed Central
Author	Lilli, Livia Santoro, Mario Masiello, Valeria Patarnello, Stefano Tagliaferri, Luca Marazzi, Fabio Capocchiano, Nikola Dino
Abstract	Background Analysis of Electronic Health Records (EHRs) is crucial in real-world evidence (RWE), especially in oncology, as it provides valuable insights into the complex nature of the disease. The implementation of advanced techniques for automated extraction of structured information from textual data potentially enables access to expert knowledge in highly specialized contexts. In this paper, we introduce MISTIC, a Natural Language Processing (NLP) approach to classify the presence or absence of metastasis in Italian EHRs, in the breast cancer domain. Methods Our approach consists of a transformer-based framework designed for few-shot learning, requiring a small labelled dataset and minimal computational resources for training. The pipeline includes text segmentation to improve model processing and topic analysis to filter informative content, ensuring relevant input data for classification. Results MISTIC was evaluated across multiple data sources, and compared to several benchmark methodologies, ranging from a pattern-matching system, composed of regex and semantic rules, to BERT-based models implemented in a zero-shot learning setup and Large Language Models (LLMs). The results demonstrate the generalization of our approach, achieving an F-Score above 87% on all the sources, and outperforming the other experiments, with an overall F-Score of 91.2%. Conclusions MISTIC achieves high performance in the Italian metastasis classification task, outperforming rule-based systems, zero-shot BERT models, and LLMs. Its few-shot learning setup offers a computationally efficient alternative to large-scale models, while its segmentation and topic analysis steps enhance explainability by explicitly linking predictions to key textual elements. Furthermore, MISTIC demonstrates strong generalization across different data sources, reinforcing its potential as a scalable and transparent solution for clinical text classification. By extracting high-quality metastatic information from diverse textual data, MISTIC supports medical researchers in analyzing unstructured and highly informative content across a wide range of medical reports. In doing so, it enhances data accessibility and interpretability, addressing a critical gap in health informatics and clinical practice.
Related Links	https://bmcmedinformdecismak.biomedcentral.com/counter/pdf/10.1186/s12911-025-02994-w.pdf
Ending Page	11
Page Count	11
Starting Page	1
File Format	HTM / HTML
ISSN	14726947
DOI	10.1186/s12911-025-02994-w
Journal	BMC Medical Informatics and Decision Making
Issue Number	1
Volume Number	25
Language	English
Publisher	BioMed Central
Publisher Date	2025-04-10
Access Restriction	Open
Subject Keyword	Health Informatics Information Systems and Communication Service Management of Computing and Information Systems Metastatic breast cancer Natural language processing Sentence transformer Large language model Few shot learning Electronic health record
Content Type	Text
Resource Type	Article
Subject	Health Informatics Computer Science Applications Health Policy
Journal Impact Factor	3.3/2023
5-Year Journal Impact Factor	3.9/2023

Sl.	Authority	Responsibilities	Communication Details
1	Ministry of Education (GoI), Department of Higher Education	Sanctioning Authority	https://www.education.gov.in/ict-initiatives
2	Indian Institute of Technology Kharagpur	Host Institute of the Project: The host institute of the project is responsible for providing infrastructure support and hosting the project	https://www.iitkgp.ac.in
3	National Digital Library of India Office, Indian Institute of Technology Kharagpur	The administrative and infrastructural headquarters of the project	Dr. B. Sutradhar bsutra@ndl.gov.in
4	Project PI / Joint PI	Principal Investigator and Joint Principal Investigators of the project	Dr. B. Sutradhar bsutra@ndl.gov.in Prof. Saswat Chakrabarti will be added soon
5	Website/Portal (Helpdesk)	Queries regarding NDLI and its services	support@ndl.gov.in
6	Contents and Copyright Issues	Queries related to content curation and copyright issues	content@ndl.gov.in
7	National Digital Library of India Club (NDLI Club)	Queries related to NDLI Club formation, support, user awareness program, seminar/symposium, collaboration, social media, promotion, and outreach	clubsupport@ndl.gov.in
8	Digital Preservation Centre (DPC)	Assistance with digitizing and archiving copyright-free printed books	dpc@ndl.gov.in
9	IDR Setup or Support	Queries related to establishment and support of Institutional Digital Repository (IDR) and IDR workshops	idr@ndl.gov.in

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