Pairing-free Group-level Knowledge Distillation for Robust Gastrointestinal Lesion Classification in White-Light Endoscopy

White-Light Imaging (WLI) is the standard for endoscopic cancer screening, but Narrow-Band Imaging (NBI) offers superior diagnostic details. A key challenge is transferring knowledge from NBI to enhance WLI-only models, yet existing methods are critically hampered by their reliance on paired NBI-WLI images of the same lesion, a costly and often impractical requirement that leaves vast amounts of clinical data untapped. In this paper, we break this paradigm by introducing PaGKD, a novel Pairing-free Group-level Knowledge Distillation framework that that enables effective cross-modal learning using unpaired WLI and NBI data. Instead of forcing alignment between individual, often semantically mismatched image instances, PaGKD operates at the group level to distill more complete and compatible knowledge across modalities. Central to PaGKD are two complementary modules: (1) Group-level Prototype Distillation (GKD-Pro) distills compact group representations by extracting modality-invariant semantic prototypes via shared lesion-aware queries; (2) Group-level Dense Distillation (GKD-Den) performs dense cross-modal alignment by guiding group-aware attention with activation-derived relation maps. Together, these modules enforce global semantic consistency and local structural coherence without requiring image-level correspondence. Extensive experiments on four clinical datasets demonstrate that PaGKD consistently and significantly outperforms state-of-the-art methods, achieving relative AUC improvements of 3.3%, 1.1%, 2.8%, and 3.2%, respectively, establishing a new direction for cross-modal learning from unpaired data.

Holistic White-light Polyp Classification via Alignment-free Dense Distillation of Auxiliary Optical Chromoendoscopy

White Light Imaging (WLI) and Narrow Band Imaging (NBI) are the two main colonoscopic modalities for polyp classification. While NBI, as optical chromoendoscopy, offers valuable vascular details, WLI remains the most common and often the only available modality in resource-limited settings. However, WLI-based methods typically underperform, limiting their clinical applicability. Existing approaches transfer knowledge from NBI to WLI through global feature alignment but often rely on cropped lesion regions, which are susceptible to detection errors and neglect contextual and subtle diagnostic cues. To address this, this paper proposes a novel holistic classification framework that leverages full-image diagnosis without requiring polyp localization. The key innovation lies in the Alignment-free Dense Distillation (ADD) module, which enables fine-grained cross-domain knowledge distillation regardless of misalignment between WLI and NBI images. Without resorting to explicit image alignment, ADD learns pixel-wise cross-domain affinities to establish correspondences between feature maps, guiding the distillation along the most relevant pixel connections. To further enhance distillation reliability, ADD incorporates Class Activation Mapping (CAM) to filter cross-domain affinities, ensuring the distillation path connects only those semantically consistent regions with equal contributions to polyp diagnosis. Extensive results on public and in-house datasets show that our method achieves state-of-the-art performance, relatively outperforming the other approaches by at least 2.5% and 16.2% in AUC, respectively. Code is available at: https://github.com/Huster-Hq/ADD.