这篇论文发了个叫ScaFE的方法，让LLM写图像特征程序来分类疤痕，照片不用出本地，比BiomedCLIP高10个点，数据少也够用。
ScaFE将临床知识从大语言模型转移到确定性的可执行特征程序，而非直接让模型诊断图像。在来自三家医院的600张照片上，ScaFE达到81.0%的站点宏平衡准确率，比最强基线BiomedCLIP高出10.0个百分点。仅用10%的开发数据时，ScaFE保持72.0%的平衡准确率，仍领先11.8个百分点。迭代修复将可执行程序率从66.7%提升到95.0%，91.7%的最终特征有验证证据。该方法表明LLM知识能通过本地可审计的特征程序支持跨医院的医学图像分类。
ScaFE: Data-Efficient Scar Classification with LLM-Generated Clinical Feature Programs
Classifying pathological scars from clinical photographs requires distinguishing keloids from hypertrophic scars despite limited expert-labeled data and substantial acquisition variation across hospitals. End-to-end image models remain data-dependent, whereas sending photographs to a hosted vision-language model (VLM) may conflict with local data-governance requirements and yields decisions that are difficult to reproduce and audit. We introduce ScaFE (Scar Feature Engineering), which transfers clinical knowledge from a large language model (LLM) into deterministic, executable feature programs instead of asking the model to diagnose images. A web-enabled LLM retrieves clinical evidence and synthesizes programs that measure visually assessable scar attributes. Candidate programs execute in a restricted local environment, and only aggregate validation statistics and feature-level SHAP summaries are returned for iterative repair and refinement; raw images and patient-level outputs remain local. A lightweight Random Forest then operates on the resulting structured representation. On 600 photographs from three hospitals under leave-one-site-out evaluation, ScaFE achieves 81.0% site-macro balanced accuracy, exceeding the strongest baseline, BiomedCLIP, by 10.0 percentage points. With only 10% of the development data, ScaFE retains 72.0% balanced accuracy and an 11.8-point lead. Iterative refinement also raises the executable-program rate from 66.7% to 95.0%, with verified evidence for 91.7% of the final features. These results show that LLM knowledge can support data-efficient, cross-site medical image classification through local and auditable feature programs rather than direct VLM decisions.