# Cross-Lingual Clinical Annotation Projection as Constrained Text Generation: A Six-Language Study

arXiv: https://arxiv.org/abs/2609.11450 · HTML: https://mlsanity.com/paper/2609.11450/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 6 of its 31 references that are in the map.
- First posted on arXiv 10 Sep 2026.

## Builds on (most cited first, 6 of 6)

- [XGBoost: A Scalable Tree Boosting System](https://mlsanity.com/paper/1603.02754/) (2016)
- [Word Alignment by Fine-tuning Embeddings on Parallel Corpora](https://mlsanity.com/paper/2101.08231/) (2021)
- [SimAlign: High Quality Word Alignments without Parallel Training Data using Static and Contextualized Embeddings](https://mlsanity.com/paper/2004.08728/) (2020)
- [Weakly Supervised Cross-Lingual Named Entity Recognition via Effective Annotation and Representation Projection](https://mlsanity.com/paper/1707.02483/) (2017)
- [FRASIMED: a Clinical French Annotated Resource Produced through Crosslingual BERT-Based Annotation Projection](https://mlsanity.com/paper/2309.10770/) (2023)
- [Revisiting Projection-based Data Transfer for Cross-Lingual Named Entity Recognition in Low-Resource Languages](https://mlsanity.com/paper/2501.18750/) (2025)

## Abstract (arXiv)

Background: To determine whether cross-lingual clinical annotation projection can be formulated as a text-preserving, document-level generative task that produces verifiable character-level annotations for multilingual clinical corpus construction, and to characterize its robustness and computational trade-offs relative to candidate-based projection pipelines. Methods: We developed a constrained LLM projection workflow that inserts entity tags directly into immutable target-language text, followed by deterministic validation and character-offset reconstruction. We evaluated it alongside supervised candidate-span projection and hybrid ML-LLM refinement for transferring Spanish Disease, Symptom, and Procedure annotations into six languages. Evaluation used MultiClinAI gold standard with strict span matching and character-overlap F1 Results: Direct LLM projection achieved the strongest and most consistent performance. GLM 5.2 obtained a mean Strict F1 of 0.9201 across 18 language-entity combinations, while locally deployable Gemma4:31B achieved 0.9133. The best LLM configuration improved Strict F1 over the previous state of the art in all 18 settings, by 0.0564-0.1512, yielding 55,416 grounded mentions with reconstructed offsets. Conclusions: Direct LLM-based projection enables high-quality multilingual clinical annotation transfer and provides a practical approach for extending clinical NLP resources to languages with fewer annotated datasets and language-specific tools. Combined with local inference and deterministic validation, it can substantially reduce expert time and cost for multilingual clinical corpus construction.