SNO-PI: Label-Scarce SNOMED CT Entity Linking with Pre-trained Encoders and Curated Terminology Knowledge

Abstract

We present SNO-PI, the top-performing submission on SNOMED International's SNOMED CT Entity Linking Benchmark as of 18 October 2026. SNO-PI achieves a macro character IoU of 0.5387, outperforming the organisers' reference system (0.4582; based on the 2024 challenge winner's approach) by 18% relative. Linking clinical mentions to SNOMED CT is a zero- and few-shot problem over a very large label space: the 272 annotated MIMIC-IV discharge summaries cover only 6,595 of the roughly 219,000 eligible concepts, and a third of those occur only once. This motivates a design built on transfer from pre-trained models and human-curated knowledge. SNO-PI combines high-recall span proposal, SapBERT candidate retrieval and listwise ensemble reranking with three BERT-family encoders, each further pre-trained with masked language modelling on unlabelled MIMIC-IV notes and then on SNOMED CT synonyms and hierarchy before task fine-tuning. We find that curated knowledge helps most on concepts never seen in training, yet these concepts remain the main source of error.