# VERGE: Verification-Enhanced Refinement for Grounded Extraction of Early-Onset Colorectal Cancer Symptoms in Clinical Notes

arXiv: https://arxiv.org/abs/2609.04366 · HTML: https://mlsanity.com/paper/2609.04366/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 9 of its 27 references that are in the map.
- First posted on arXiv 3 Sep 2026.

## Builds on (most cited first, 9 of 9)

- [BERTScore: Evaluating Text Generation with BERT](https://mlsanity.com/paper/1904.09675/) (2019)
- [BioBERT: a pre-trained biomedical language representation model for biomedical text mining](https://mlsanity.com/paper/1901.08746/) (2019)
- [Publicly Available Clinical BERT Embeddings](https://mlsanity.com/paper/1904.03323/) (2019)
- [MedAgents: Large Language Models as Collaborators for Zero-shot Medical Reasoning](https://mlsanity.com/paper/2311.10537/) (2023)
- [MedCPT: Contrastive Pre-trained Transformers with Large-scale PubMed Search Logs for Zero-shot Biomedical Information Retrieval](https://mlsanity.com/paper/2307.00589/) (2023)
- [MDAgents: An Adaptive Collaboration of LLMs for Medical Decision-Making](https://mlsanity.com/paper/2404.15155/) (2024)
- [Launching into clinical space with medspaCy: a new clinical text processing toolkit in Python](https://mlsanity.com/paper/2106.07799/) (2021)
- [Document-level Clinical Entity and Relation Extraction via Knowledge Base-Guided Generation](https://mlsanity.com/paper/2407.10021/) (2024)
- [Multimodal Routing for Interpretable, Robust, and Auditable Clinical Prediction](https://mlsanity.com/paper/2607.09982/) (2026)

## Abstract (arXiv)

Early-onset colorectal cancer is increasing among younger adults, yet red-flag symptoms in this age group have no evidence-based guidelines for follow-up testing, and structured encounter data do not capture the detail needed to support early detection and inform follow-up, including symptom duration, context, and fam- ily history, an established colorectal-cancer risk factor. This study aimed to develop and evaluate an automated method for extracting six red-flag symptoms and family-history risk status from free-text clinical notes. We developed VERGE, an agentic workflow in which an initial label and evidence are proposed using retrieval-augmented generation, then passed through a bounded verification- refinement cycle that checks textual grounding and clinical validity, corrects and rechecks a claim until resolved or a limit is reached, and escalates unresolved claims for human review. VERGE was evaluated on 4,033 clinician-labeled note-finding pairs against a single-agent baseline, a rule-based clinical language-processing baseline, and an alternative underlying language model. Compared with the single-agent baseline, VERGE reduced false positive find- ings, improving precision from 0.764 to 0.849 and MCC from 0.681 to 0.730, a balanced gain across the precision-recall trade-off, and resolved most flagged errors autonomously, with human review required for only 1.5 percent of claims. These results indicate that a bounded, verification-based workflow can reduce unnecessary positive findings without sacrificing the ability to detect true ones. This approach offers a path toward more reliable and trustworthy clinical language-processing tools to support colorectal cancer risk assessment in younger patients.