# Semantic-Topological Graph Reasoning for Language-Guided Pulmonary Screening

arXiv: https://arxiv.org/abs/2604.05620 · HTML: https://mlsanity.com/paper/2604.05620/

## Key facts

- Cited by 1 papers in the map (data through 14 Oct 2026).
- Placed in Clinical and biomedical applications, one of 17 directions in LLM reasoning.
- Builds on 15 of its 23 references that are in the map.
- First posted on arXiv 7 Apr 2026.

## Placed in

- LLM reasoning / [Clinical and biomedical applications](https://mlsanity.com/lr/clinical-and-biomedical-applications/)

## Builds on (most cited first, 15 of 15)

- [U-Net: Convolutional Networks for Biomedical Image Segmentation](https://mlsanity.com/paper/1505.04597/) (2015)
- [The Llama 3 Herd of Models](https://mlsanity.com/paper/2407.21783/) (2024)
- [DINOv2: Learning Robust Visual Features without Supervision](https://mlsanity.com/paper/2304.07193/) (2023)
- [Grounding DINO: Marrying DINO with Grounded Pre-Training for Open-Set Object Detection](https://mlsanity.com/paper/2303.05499/) (2023)
- [TransUNet: Transformers Make Strong Encoders for Medical Image Segmentation](https://mlsanity.com/paper/2102.04306/) (2021)
- [SegNet: A Deep Convolutional Encoder-Decoder Architecture for Image Segmentation](https://mlsanity.com/paper/1511.00561/) (2015)
- [LISA: Reasoning Segmentation via Large Language Model](https://mlsanity.com/paper/2308.00692/) (2023)
- [Segment Everything Everywhere All at Once](https://mlsanity.com/paper/2304.06718/) (2023)
- [LNDb: A Lung Nodule Database on Computed Tomography](https://mlsanity.com/paper/1911.08434/) (2019)
- [DeepGB-TB: A Risk-Balanced Cross-Attention Gradient-Boosted Convolutional Network for Rapid, Interpretable Tuberculosis Screening](https://mlsanity.com/paper/2508.02741/) (2025)
- [Causal-SAM-LLM: Large Language Models as Causal Reasoners for Robust Medical Segmentation](https://mlsanity.com/paper/2507.03585/) (2025)
- [SkinCLIP-VL: Consistency-Aware Vision-Language Learning for Multimodal Skin Cancer Diagnosis](https://mlsanity.com/paper/2603.21010/) (2026)
- [PRISM: A Personality-Driven Multi-Agent Framework for Social Media Simulation](https://mlsanity.com/paper/2512.19933/) (2025)
- [SAGE: Sustainable Agent-Guided Expert-tuning for Culturally Attuned Translation in Low-Resource Southeast Asia](https://mlsanity.com/paper/2603.19931/) (2026)
- [MERIT: Multilingual Expert-Reward Informed Tuning for Chinese-Centric Low-Resource Machine Translation](https://mlsanity.com/paper/2604.04839/) (2026)

## Built on by (most cited first, 1 of 1)

- [TAVR-VLM: Risk-Conditioned Causal Grounding for Hallucination-Resistant Report Generation](https://mlsanity.com/paper/2606.26874/) (2026)

## Abstract (arXiv)

Medical image segmentation driven by free-text clinical instructions is a critical frontier in computer-aided diagnosis. However, existing multimodal and foundation models struggle with the semantic ambiguity of clinical reports and fail to disambiguate complex anatomical overlaps in low-contrast scans. Furthermore, fully fine-tuning these massive architectures on limited medical datasets invariably leads to severe overfitting. To address these challenges, we propose a novel Semantic-Topological Graph Reasoning (STGR) framework for language-guided pulmonary screening. Our approach elegantly synergizes the reasoning capabilities of large language models (LLaMA-3-V) with the zero-shot delineation of vision foundation models (MedSAM). Specifically, we introduce a Text-to-Vision Intent Distillation (TVID) module to extract precise diagnostic guidance. To resolve anatomical ambiguity, we formulate mask selection as a dynamic graph reasoning problem, where candidate lesions are modeled as nodes and edges capture spatial and semantic affinities. To ensure deployment feasibility, we introduce a Selective Asymmetric Fine-Tuning (SAFT) strategy that updates less than 1% of the parameters. Rigorous 5-fold cross-validation on the LIDC-IDRI and LNDb datasets demonstrates that our framework establishes a new state-of-the-art. Notably, it achieves an 81.5% Dice Similarity Coefficient (DSC) on LIDC-IDRI, outperforming leading LLM-based tools like LISA by over 5%. Crucially, our SAFT strategy acts as a powerful regularizer, yielding exceptional cross-fold stability (0.6% DSC variance) and paving the way for robust, context-aware clinical deployment.