# Pathology-Aware Prototype Evolution via LLM-Driven Semantic Disambiguation for Multicenter Diabetic Retinopathy Diagnosis

arXiv: https://arxiv.org/abs/2511.22033 · HTML: https://mlsanity.com/paper/2511.22033/

## Key facts

- Cited by 22 papers in the map (data through 14 Oct 2026).
- Builds on 19 of its 54 references that are in the map.
- First posted on arXiv 27 Nov 2025.

## Builds on (most cited first, 19 of 19)

- [An Image is Worth 16x16 Words: Transformers for Image Recognition at Scale](https://mlsanity.com/paper/2010.11929/) (2020)
- [mixup: Beyond Empirical Risk Minimization](https://mlsanity.com/paper/1710.09412/) (2017)
- [Prototypical Networks for Few-shot Learning](https://mlsanity.com/paper/1703.05175/) (2017)
- [Deeper, Broader and Artier Domain Generalization](https://mlsanity.com/paper/1710.03077/) (2017)
- [Domain Generalization with MixStyle](https://mlsanity.com/paper/2104.02008/) (2021)
- [Med-Flamingo: a Multimodal Medical Few-shot Learner](https://mlsanity.com/paper/2307.15189/) (2023)
- [FedDG: Federated Domain Generalization on Medical Image Segmentation via Episodic Learning in Continuous Frequency Space](https://mlsanity.com/paper/2103.06030/) (2021)
- [Deep Domain-Adversarial Image Generation for Domain Generalisation](https://mlsanity.com/paper/2003.06054/) (2020)
- [Learning Robust Representations by Projecting Superficial Statistics Out](https://mlsanity.com/paper/1903.06256/) (2019)
- [See, Think, Confirm: Interactive Prompting Between Vision and Language Models for Knowledge-based Visual Reasoning](https://mlsanity.com/paper/2301.05226/) (2023)
- [A Benchmark for Studying Diabetic Retinopathy: Segmentation, Grading, and Transferability](https://mlsanity.com/paper/2008.09772/) (2020)
- [Generalizable Cross-modality Medical Image Segmentation via Style Augmentation and Dual Normalization](https://mlsanity.com/paper/2112.11177/) (2021)
- [Domain Generalization on Medical Imaging Classification using Episodic Training with Task Augmentation](https://mlsanity.com/paper/2106.06908/) (2021)
- [On Multi-Domain Long-Tailed Recognition, Imbalanced Domain Generalization and Beyond](https://mlsanity.com/paper/2203.09513/) (2022)
- [Towards Generalizable Diabetic Retinopathy Grading in Unseen Domains](https://mlsanity.com/paper/2307.04378/) (2023)
- [CLIP-DR: Textual Knowledge-Guided Diabetic Retinopathy Grading with Ranking-aware Prompting](https://mlsanity.com/paper/2407.04068/) (2024)
- [Follow-Up Differential Descriptions: Language Models Resolve Ambiguities for Image Classification](https://mlsanity.com/paper/2311.07593/) (2023)
- [SSiT: Saliency-guided Self-supervised Image Transformer for Diabetic Retinopathy Grading](https://mlsanity.com/paper/2210.10969/) (2022)
- [Multi-Cell Multi-Task Convolutional Neural Networks for Diabetic Retinopathy Grading](https://mlsanity.com/paper/1808.10564/) (2018)

## Built on by (most cited first, 22 of 22)

- [GaussianDWM: 3D Gaussian Driving World Model for Unified Scene Understanding and Multi-Modal Generation](https://mlsanity.com/paper/2512.23180/) (2025)
- [Med-CMR: A Fine-Grained Benchmark Integrating Visual Evidence and Clinical Logic for Medical Complex Multimodal Reasoning](https://mlsanity.com/paper/2512.00818/) (2025)
- [Real-Time Aligned Reward Model beyond Semantics](https://mlsanity.com/paper/2601.22664/) (2026)
- [MedSynapse-V: Bridging Visual Perception and Clinical Intuition via Latent Memory Evolution](https://mlsanity.com/paper/2604.26283/) (2026)
- [TEAM: Temporal-Spatial Consistency Guided Expert Activation for MoE Diffusion Language Model Acceleration](https://mlsanity.com/paper/2602.08404/) (2026)
- [TWLA: Achieving Ternary Weights and Low-Bit Activations for LLMs via Post-Training Quantization](https://mlsanity.com/paper/2606.13054/) (2026)
- [SpatialReward: Verifiable Spatial Reward Modeling for Fine-Grained Spatial Consistency in Text-to-Image Generation](https://mlsanity.com/paper/2603.22228/) (2026)
- [One Refiner to Unlock Them All: Inference-Time Reasoning Elicitation via Reinforcement Query Refinement](https://mlsanity.com/paper/2604.25444/) (2026)
- [Tracking Drift: Variation-Aware Entropy Scheduling for Non-Stationary Reinforcement Learning](https://mlsanity.com/paper/2601.19624/) (2026)
- [From Internal Diagnosis to External Auditing: A VLM-Driven Paradigm for Data-Free Online Backdoor Defense](https://mlsanity.com/paper/2601.19448/) (2026)
- [Thinking in Scales: Accelerating Gigapixel Pathology Image Analysis via Adaptive Continuous Reasoning](https://mlsanity.com/paper/2605.19491/) (2026)
- [TRACER: Token ReAssignment for Concept ERasure in Generative Recommendation](https://mlsanity.com/paper/2606.07688/) (2026)
- [REFLEX: Reflective Evolution from LLM Experience](https://mlsanity.com/paper/2606.16496/) (2026)
- [All for 1-Bit: Towards Genuine 1-Bit Post-Training Quantization for LLMs](https://mlsanity.com/paper/2609.06161/) (2026)
- [Exploring Accurate and Transparent Domain Adaptation in Predictive Healthcare via Concept-Grounded Orthogonal Inference](https://mlsanity.com/paper/2602.12542/) (2026)
- [Dynamic Model Merging Made Slim](https://mlsanity.com/paper/2605.18904/) (2026)
- [Displacement Preserving Relational Distillation for Robust Medical Segmentation](https://mlsanity.com/paper/2607.04599/) (2026)
- [Shift-Dependent Asymmetry: Orthogonal Inverse Low-Rank Adaptation for Federated Medical Segmentation](https://mlsanity.com/paper/2606.08687/) (2026)
- [TopoAgent: An Agentic Framework for Automated Topology Learning in Medical Imaging](https://mlsanity.com/paper/2606.29763/) (2026)
- [GaussianDWM++: Language-Grounded 3D Gaussian Driving World Model for Unified Scene Understanding, Editing, and Multi-Modal Generation](https://mlsanity.com/paper/2608.16234/) (2026)
- [AtomRec: Evolving Atomic Memory for Agentic Recommendation](https://mlsanity.com/paper/2609.04882/) (2026)
- [DR-LabStack: Design and Implementation of a Clinician-Facing Web System for Diabetic Retinopathy Prediction](https://mlsanity.com/paper/2609.10796/) (2026)

## Abstract (arXiv)

Diabetic retinopathy (DR) grading plays a critical role in early clinical intervention and vision preservation. Recent explorations predominantly focus on visual lesion feature extraction through data processing and domain decoupling strategies. However, they generally overlook domain-invariant pathological patterns and underutilize the rich contextual knowledge of foundation models, relying solely on visual information, which is insufficient for distinguishing subtle pathological variations. Therefore, we propose integrating fine-grained pathological descriptions to complement prototypes with additional context, thereby resolving ambiguities in borderline cases. Specifically, we propose a Hierarchical Anchor Prototype Modulation (HAPM) framework to facilitate DR grading. First, we introduce a variance spectrum-driven anchor prototype library that preserves domain-invariant pathological patterns. We further employ a hierarchical differential prompt gating mechanism, dynamically selecting discriminative semantic prompts from both LVLM and LLM sources to address semantic confusion between adjacent DR grades. Finally, we utilize a two-stage prototype modulation strategy that progressively integrates clinical knowledge into visual prototypes through a Pathological Semantic Injector (PSI) and a Discriminative Prototype Enhancer (DPE). Extensive experiments across eight public datasets demonstrate that our approach achieves pathology-guided prototype evolution while outperforming state-of-the-art methods. The code is available at https://github.com/zhcz328/HAPM.