A query for posterior fossa arachnoid cyst returns roughly 50 trials on exact match. But clinically adjacent registrations using posterior fossa cyst, retrocerebellar cyst, or Dandy-Walker variant disappear unless someone has already done the terminology work.
That is not a data quality problem. It is a retrieval problem. Hedge funds miss enrollment signal. CROs miss competitive filings. Patient advocates miss trials people can actually enter.
The fix is a curated semantic graph built from the literature, the coding system, and the operator surface — not generic language-model expansion.