# MedCORE: Criteria-Grounded Clinical Reasoning for Interpretable Medical Image Diagnosis

arXiv: https://arxiv.org/abs/2610.08528 · HTML: https://mlsanity.com/paper/2610.08528/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Placed in Clinical and biomedical applications, one of 17 directions in LLM reasoning.
- Builds on 4 of its 32 references that are in the map.
- First posted on arXiv 6 Oct 2026.

## Placed in

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

## Builds on (most cited first, 4 of 4)

- [Graph Attention Networks](https://mlsanity.com/paper/1710.10903/) (2017)
- [Skin Lesion Analysis Toward Melanoma Detection 2018: A Challenge Hosted by the International Skin Imaging Collaboration (ISIC)](https://mlsanity.com/paper/1902.03368/) (2019)
- [BiomedCLIP: a multimodal biomedical foundation model pretrained from fifteen million scientific image-text pairs](https://mlsanity.com/paper/2303.00915/) (2023)
- [Post-hoc Concept Bottleneck Models](https://mlsanity.com/paper/2205.15480/) (2022)

## Abstract (arXiv)

Clinical diagnosis is inherently a structured reasoning process, yet existing deep learning models often bypass this structure by mapping image features directly to disease labels without explicitly interrogating the morphological and textural criteria that clinicians systematically evaluate. This limits diagnostic transparency and may compromise safe clinical deployment. We present MedCORE (Medical Criteria-Oriented Reasoning and Evidence), a structured diagnostic framework that operationalizes clinical reasoning within a vision-language architecture. For each input image, MedCORE decomposes the diagnostic process into clinically defined criteria, spatially localizes each criterion to diagnostically relevant image regions, encodes evidence through multi-scale representations that capture macro-structural and micro-textural pathological characteristics, and refines criterion representations using a Graph Attention Network that explicitly models inter-criteria dependencies. Criterion representations are further aligned with clinical text descriptors, reinforced through class-wise visual prototypes, and aggregated using uncertainty-calibrated weighting that proportionally discounts low-confidence diagnostic evidence. MedCORE is validated across three clinically heterogeneous imaging modalities, including dermoscopic lesion classification on ISIC 2018, breast ultrasound lesion characterization on BUSI, and diabetic retinopathy grading on IDRiD. Quantitatively, MedCORE achieves 89.2% accuracy, 85.7% macro-F1, and 96.4% AUC on ISIC 2018; 96.1% accuracy, 95.2% macro-F1, and 98.4% AUC on BUSI; and 84.3% accuracy, 80.2% macro-F1, and 92.8% AUC on IDRiD. These results demonstrate consistent improvements over strong CNN, transformer, biomedical vision-language, concept-based, and prototype-based baselines.