Seeing Through the Tool: A Controlled Benchmark for Occlusion Robustness in Foundation Segmentation Models

Occlusion, where target structures are partially hidden by surgical instruments or overlapping tissues, remains a critical yet underexplored challenge for foundation segmentation models in clinical endoscopy. We introduce OccSAM-Bench, a benchmark designed to systematically evaluate SAM-family models under controlled, synthesized surgical occlusion. Our framework simulates two occlusion types (i.e., surgical tool overlay and cutout) across three calibrated severity levels on three public polyp datasets. We propose a novel three-region evaluation protocol that decomposes segmentation performance into full, visible-only, and invisible targets. This metric exposes behaviors that standard amodal evaluation obscures, revealing two distinct model archetypes: Occluder-Aware models (SAM, SAM 2, SAM 3, MedSAM3), which prioritize visible tissue delineation and reject instruments, and Occluder-Agnostic models (MedSAM, MedSAM2), which confidently predict into occluded regions. SAM-Med2D aligns with neither and underperforms across all conditions. Ultimately, our results demonstrate that occlusion robustness is not uniform across architectures, and model selection must be driven by specific clinical intent-whether prioritizing conservative visible-tissue segmentation or the amodal inference of hidden anatomy.

Robust White Blood Cell Classification with Stain-Normalized Decoupled Learning and Ensembling

White blood cell (WBC) classification is fundamental for hematology applications such as infection assessment, leukemia screening, and treatment monitoring. However, real-world WBC datasets present substantial appearance variations caused by staining and scanning conditions, as well as severe class imbalance in which common cell types dominate while rare but clinically important categories are underrepresented. To address these challenges, we propose a stain-normalized, decoupled training framework that first learns transferable representations using instance-balanced sampling, and then rebalances the classifier with class-aware sampling and a hybrid loss combining effective-number weighting and focal modulation. In inference stage, we further enhance robustness by ensembling various trained backbones with test-time augmentation. Our approach achieved the top rank on the leaderboard of the WBCBench 2026: Robust White Blood Cell Classification Challenge at ISBI 2026.

Handling Supervision Scarcity in Chest X-ray Classification: Long-Tailed and Zero-Shot Learning

Chest X-ray (CXR) classification in clinical practice is often limited by imperfect supervision, arising from (i) extreme long-tailed multi-label disease distributions and (ii) missing annotations for rare or previously unseen findings. The CXR-LT 2026 challenge addresses these issues on a PadChest-based benchmark with a 36-class label space split into 30 in-distribution classes for training and 6 out-of-distribution (OOD) classes for zero-shot evaluation. We present task-specific solutions tailored to the distinct supervision regimes. For Task 1 (long-tailed multi-label classification), we adopt an imbalance-aware multi-label learning strategy to improve recognition of tail classes while maintaining stable performance on frequent findings. For Task 2 (zero-shot OOD recognition), we propose a prediction approach that produces scores for unseen disease categories without using any supervised labels or examples from the OOD classes during training. Evaluated with macro-averaged mean Average Precision (mAP), our method achieves strong performance on both tasks, ranking first on the public leaderboard of the development phase. Code and pre-trained models are available at https://github.com/hieuphamha19/CXR_LT.

From Specialist to Generalist: Unlocking SAM's Learning Potential on Unlabeled Medical Images

Foundation models like the Segment Anything Model (SAM) show strong generalization, yet adapting them to medical images remains difficult due to domain shift, scarce labels, and the inability of Parameter-Efficient Fine-Tuning (PEFT) to exploit unlabeled data. While conventional models like U-Net excel in semi-supervised medical learning, their potential to assist a PEFT SAM has been largely overlooked. We introduce SC-SAM, a specialist-generalist framework where U-Net provides point-based prompts and pseudo-labels to guide SAM's adaptation, while SAM serves as a powerful generalist supervisor to regularize U-Net. This reciprocal guidance forms a bidirectional co-training loop that allows both models to effectively exploit the unlabeled data. Across prostate MRI and polyp segmentation benchmarks, our method achieves state-of-the-art results, outperforming other existing semi-supervised SAM variants and even medical foundation models like MedSAM, highlighting the value of specialist-generalist cooperation for label-efficient medical image segmentation. Our code is available at https://github.com/vnlvi2k3/SC-SAM.

Domain-invariant Mixed-domain Semi-supervised Medical Image Segmentation with Clustered Maximum Mean Discrepancy Alignment

Deep learning has shown remarkable progress in medical image semantic segmentation, yet its success heavily depends on large-scale expert annotations and consistent data distributions. In practice, annotations are scarce, and images are collected from multiple scanners or centers, leading to mixed-domain settings with unknown domain labels and severe domain gaps. Existing semi-supervised or domain adaptation approaches typically assume either a single domain shift or access to explicit domain indices, which rarely hold in real-world deployment. In this paper, we propose a domain-invariant mixed-domain semi-supervised segmentation framework that jointly enhances data diversity and mitigates domain bias. A Copy-Paste Mechanism (CPM) augments the training set by transferring informative regions across domains, while a Cluster Maximum Mean Discrepancy (CMMD) block clusters unlabeled features and aligns them with labeled anchors via an MMD objective, encouraging domain-invariant representations. Integrated within a teacher-student framework, our method achieves robust and precise segmentation even with very few labeled examples and multiple unknown domain discrepancies. Experiments on Fundus and M&Ms benchmarks demonstrate that our approach consistently surpasses semi-supervised and domain adaptation methods, establishing a potential solution for mixed-domain semi-supervised medical image segmentation.

FUGC: Benchmarking Semi-Supervised Learning Methods for Cervical Segmentation

Accurate segmentation of cervical structures in transvaginal ultrasound (TVS) is critical for assessing the risk of spontaneous preterm birth (PTB), yet the scarcity of labeled data limits the performance of supervised learning approaches. This paper introduces the Fetal Ultrasound Grand Challenge (FUGC), the first benchmark for semi-supervised learning in cervical segmentation, hosted at ISBI 2025. FUGC provides a dataset of 890 TVS images, including 500 training images, 90 validation images, and 300 test images. Methods were evaluated using the Dice Similarity Coefficient (DSC), Hausdorff Distance (HD), and runtime (RT), with a weighted combination of 0.4/0.4/0.2. The challenge attracted 10 teams with 82 participants submitting innovative solutions. The best-performing methods for each individual metric achieved 90.26\% mDSC, 38.88 mHD, and 32.85 ms RT, respectively. FUGC establishes a standardized benchmark for cervical segmentation, demonstrates the efficacy of semi-supervised methods with limited labeled data, and provides a foundation for AI-assisted clinical PTB risk assessment.

Imaging-anchored Multiomics in Cardiovascular Disease: Integrating Cardiac Imaging, Bulk, Single-cell, and Spatial Transcriptomics

Cardiovascular disease arises from interactions between inherited risk, molecular programmes, and tissue-scale remodelling that are observed clinically through imaging. Health systems now routinely generate large volumes of cardiac MRI, CT and echocardiography together with bulk, single-cell and spatial transcriptomics, yet these data are still analysed in separate pipelines. This review examines joint representations that link cardiac imaging phenotypes to transcriptomic and spatially resolved molecular states. An imaging-anchored perspective is adopted in which echocardiography, cardiac MRI and CT define a spatial phenotype of the heart, and bulk, single-cell and spatial transcriptomics provide cell-type- and location-specific molecular context. The biological and technical characteristics of these modalities are first summarised, and representation-learning strategies for each are outlined. Multimodal fusion approaches are reviewed, with emphasis on handling missing data, limited sample size, and batch effects. Finally, integrative pipelines for radiogenomics, spatial molecular alignment, and image-based prediction of gene expression are discussed, together with common failure modes, practical considerations, and open challenges. Spatial multiomics of human myocardium and atherosclerotic plaque, single-cell and spatial foundation models, and multimodal medical foundation models are collectively bringing imaging-anchored multiomics closer to large-scale cardiovascular translation.

DualProtoSeg: Simple and Efficient Design with Text- and Image-Guided Prototype Learning for Weakly Supervised Histopathology Image Segmentation

Weakly supervised semantic segmentation (WSSS) in histopathology seeks to reduce annotation cost by learning from image-level labels, yet it remains limited by inter-class homogeneity, intra-class heterogeneity, and the region-shrinkage effect of CAM-based supervision. We propose a simple and effective prototype-driven framework that leverages vision-language alignment to improve region discovery under weak supervision. Our method integrates CoOp-style learnable prompt tuning to generate text-based prototypes and combines them with learnable image prototypes, forming a dual-modal prototype bank that captures both semantic and appearance cues. To address oversmoothing in ViT representations, we incorporate a multi-scale pyramid module that enhances spatial precision and improves localization quality. Experiments on the BCSS-WSSS benchmark show that our approach surpasses existing state-of-the-art methods, and detailed analyses demonstrate the benefits of text description diversity, context length, and the complementary behavior of text and image prototypes. These results highlight the effectiveness of jointly leveraging textual semantics and visual prototype learning for WSSS in digital pathology.

ConStruct: Structural Distillation of Foundation Models for Prototype-Based Weakly Supervised Histopathology Segmentation

Weakly supervised semantic segmentation (WSSS) in histopathology relies heavily on classification backbones, yet these models often localize only the most discriminative regions and struggle to capture the full spatial extent of tissue structures. Vision-language models such as CONCH offer rich semantic alignment and morphology-aware representations, while modern segmentation backbones like SegFormer preserve fine-grained spatial cues. However, combining these complementary strengths remains challenging, especially under weak supervision and without dense annotations. We propose a prototype learning framework for WSSS in histopathological images that integrates morphology-aware representations from CONCH, multi-scale structural cues from SegFormer, and text-guided semantic alignment to produce prototypes that are simultaneously semantically discriminative and spatially coherent. To effectively leverage these heterogeneous sources, we introduce text-guided prototype initialization that incorporates pathology descriptions to generate more complete and semantically accurate pseudo-masks. A structural distillation mechanism transfers spatial knowledge from SegFormer to preserve fine-grained morphological patterns and local tissue boundaries during prototype learning. Our approach produces high-quality pseudo masks without pixel-level annotations, improves localization completeness, and enhances semantic consistency across tissue types. Experiments on BCSS-WSSS datasets demonstrate that our prototype learning framework outperforms existing WSSS methods while remaining computationally efficient through frozen foundation model backbones and lightweight trainable adapters.

Modality-Specific Enhancement and Complementary Fusion for Semi-Supervised Multi-Modal Brain Tumor Segmentation

Semi-supervised learning (SSL) has become a promising direction for medical image segmentation, enabling models to learn from limited labeled data alongside abundant unlabeled samples. However, existing SSL approaches for multi-modal medical imaging often struggle to exploit the complementary information between modalities due to semantic discrepancies and misalignment across MRI sequences. To address this, we propose a novel semi-supervised multi-modal framework that explicitly enhances modality-specific representations and facilitates adaptive cross-modal information fusion. Specifically, we introduce a Modality-specific Enhancing Module (MEM) to strengthen semantic cues unique to each modality via channel-wise attention, and a learnable Complementary Information Fusion (CIF) module to adaptively exchange complementary knowledge between modalities. The overall framework is optimized using a hybrid objective combining supervised segmentation loss and cross-modal consistency regularization on unlabeled data. Extensive experiments on the BraTS 2019 (HGG subset) demonstrate that our method consistently outperforms strong semi-supervised and multi-modal baselines under 1\%, 5\%, and 10\% labeled data settings, achieving significant improvements in both Dice and Sensitivity scores. Ablation studies further confirm the complementary effects of our proposed MEM and CIF in bridging cross-modality discrepancies and improving segmentation robustness under scarce supervision.