| name | chart-review-cancer-diagnosis |
| description | Extract cancer histology type, distant-metastasis status, and local-recurrence status from a patient's clinical notes; disease extent is computed from the latter two. Evidence-cited. Triggers on: cancer type, histology, disease extent, metastatic, local recurrence.
|
Procedure
This is a notes-only, pan-cancer phenotype task. You answer three leaf fields
directly:
cancer_type — the histology type (enum).has_distant_metastasis — yes / no_info (no separate no: "documented negative" and "not addressed" are both no_info).has_local_recurrence — yes / no_info (same — only yes or no_info).
disease_extent is a computed field (derived from has_distant_metastasis
and has_local_recurrence) — do NOT answer it directly.
-
list_notes to see the chart. Prioritize pathology / surgical-pathology /
biopsy / cytology notes first, then treating-oncologist progress notes,
then imaging. On a large chart, use search_notes for high-signal terms
("final diagnosis", "carcinoma", "metastatic", "stage IV", "M1",
"recurrence") to jump to the relevant spans instead of reading everything.
Use read_note/read_notes to read the candidates in full.
-
list_criteria + read_criteria(["cancer_type", "has_distant_metastasis", "has_local_recurrence"]) to get each field's enum of allowed answers and its
extraction guidance. Follow the criterion's mappings and no_info rules
exactly.
-
For each leaf field, commit one answer via
set_field_assessment(field_id, answer, confidence, evidence, rationale).
The answer MUST be one of the field's enum values.
Evidence rules — cite the SMALLEST span that supports the answer:
- Quote the single sentence/phrase that justifies it (well under ~300 chars).
Prefer the pathology "FINAL DIAGNOSIS" line. Use
find_quote_offsets
to get exact offsets so the faithfulness gate passes.
- Do NOT cite the whole note. A full-document citation is not acceptable.
- The cited span must be affirmative — never cite "no evidence of
metastatic disease" to support
has_distant_metastasis=yes; a negation
means the answer is no_info, not yes.
- For
no_info: ALWAYS cite one short span — the section you checked
where the info would appear if present (Assessment/Plan, Diagnosis, Staging).
Decision rules (apply to all leaf fields)
- Source priority: surgical pathology > biopsy/cytology pathology >
treating-oncologist note > imaging. Read pathology first.
- Affirmative only: extract only what is affirmatively documented for THIS
patient. Never infer or guess. Exclude negated findings ("no evidence
of…", "rule out…") and family history ("mother with … cancer").
- Distant vs regional:
has_distant_metastasis=yes requires distant (M1)
spread — a named distant organ or distant nodes, or M1/Stage IV. Regional
nodes (N1/N2/N3) are NOT distant → no.
- Recurrence:
has_local_recurrence=yes requires an explicit recurrence
word ("recurrent/relapse/locally recurrent") after prior definitive treatment;
a positive margin alone is not recurrence.
- Conflicts: if notes disagree, take the higher-priority source (and, for
histology, the most recent pathology); record the conflict in
rationale.
- Confidence:
high = explicit pathology final diagnosis or explicit
staging (M1/Stage IV); medium = oncologist narrative / inferred mapping;
low = imaging-only or ambiguous → prefer no_info over a low-confidence guess.
- Commit the THREE leaf fields (
cancer_type, has_distant_metastasis,
has_local_recurrence) via set_field_assessment before finishing — every
leaf must have a value (use no_info if absent). Do NOT commit
disease_extent — it is derived automatically from the two has_* fields.
Do NOT call set_review_status. Once the three leaves are committed, emit
a one-line summary and stop.
