A Machine Vision Approach to Preliminary Skin Lesion Assessments

Early detection of malignant skin lesions is critical for improving patient outcomes in aggressive, metastatic skin cancers. This study evaluates a comprehensive system for preliminary skin lesion assessment that combines the clinically established ABCD rule of dermoscopy (analyzing Asymmetry, Borders, Color, and Dermoscopic Structures) with machine learning classification. Using a 1,000-image subset of the HAM10000 dataset, the system implements an automated, rule-based pipeline to compute a Total Dermoscopy Score (TDS) for each lesion. This handcrafted approach is compared against various machine learning solutions, including traditional classifiers (Logistic Regression, Random Forest, and SVM) and deep learning models. While the rule-based system provides high clinical interpretability, results indicate a performance bottleneck when reducing complex morphology to five numerical features. Experimental findings show that transfer learning with EfficientNet-B0 failed significantly due to domain shift between natural and medical images. In contrast, a custom three-layer Convolutional Neural Network (CNN) trained from scratch achieved 78.5% accuracy and 86.5% recall on median-filtered images, representing a 19-point accuracy improvement over traditional methods. The results demonstrate that direct pixel-level learning captures diagnostic patterns beyond handcrafted features and that purpose-built lightweight architectures can outperform large pretrained models for small, domain-specific medical datasets.

PMPBench: A Paired Multi-Modal Pan-Cancer Benchmark for Medical Image Synthesis

Contrast medium plays a pivotal role in radiological imaging, as it amplifies lesion conspicuity and improves detection for the diagnosis of tumor-related diseases. However, depending on the patient's health condition or the medical resources available, the use of contrast medium is not always feasible. Recent work has explored AI-based image translation to synthesize contrast-enhanced images directly from non-contrast scans, aims to reduce side effects and streamlines clinical workflows. Progress in this direction has been constrained by data limitations: (1) existing public datasets focus almost exclusively on brain-related paired MR modalities; (2) other collections include partially paired data but suffer from missing modalities/timestamps and imperfect spatial alignment; (3) explicit labeling of CT vs. CTC or DCE phases is often absent; (4) substantial resources remain private. To bridge this gap, we introduce the first public, fully paired, pan-cancer medical imaging dataset spanning 11 human organs. The MR data include complete dynamic contrast-enhanced (DCE) sequences covering all three phases (DCE1-DCE3), while the CT data provide paired non-contrast and contrast-enhanced acquisitions (CTC). The dataset is curated for anatomical correspondence, enabling rigorous evaluation of 1-to-1, N-to-1, and N-to-N translation settings (e.g., predicting DCE phases from non-contrast inputs). Built upon this resource, we establish a comprehensive benchmark. We report results from representative baselines of contemporary image-to-image translation. We release the dataset and benchmark to catalyze research on safe, effective contrast synthesis, with direct relevance to multi-organ oncology imaging workflows. Our code and dataset are publicly available at https://github.com/YifanChen02/PMPBench.

Deep Learning-Based Fixation Type Prediction for Quality Assurance in Digital Pathology

Accurate annotation of fixation type is a critical step in slide preparation for pathology laboratories. However, this manual process is prone to errors, impacting downstream analyses and diagnostic accuracy. Existing methods for verifying formalin-fixed, paraffin-embedded (FFPE), and frozen section (FS) fixation types typically require full-resolution whole-slide images (WSIs), limiting scalability for high-throughput quality control. We propose a deep-learning model to predict fixation types using low-resolution, pre-scan thumbnail images. The model was trained on WSIs from the TUM Institute of Pathology (n=1,200, Leica GT450DX) and evaluated on a class-balanced subset of The Cancer Genome Atlas dataset (TCGA, n=8,800, Leica AT2), as well as on class-balanced datasets from Augsburg (n=695 [392 FFPE, 303 FS], Philips UFS) and Regensburg (n=202, 3DHISTECH P1000). Our model achieves an AUROC of 0.88 on TCGA, outperforming comparable pre-scan methods by 4.8%. It also achieves AUROCs of 0.72 on Regensburg and Augsburg slides, underscoring challenges related to scanner-induced domain shifts. Furthermore, the model processes each slide in 21 ms, $400\times$ faster than existing high-magnification, full-resolution methods, enabling rapid, high-throughput processing. This approach provides an efficient solution for detecting labelling errors without relying on high-magnification scans, offering a valuable tool for quality control in high-throughput pathology workflows. Future work will improve and evaluate the model's generalisation to additional scanner types. Our findings suggest that this method can increase accuracy and efficiency in digital pathology workflows and may be extended to other low-resolution slide annotations.

The Impact of Lesion Focus on the Performance of AI-Based Melanoma Classification

Melanoma is the most lethal subtype of skin cancer, and early and accurate detection of this disease can greatly improve patients' outcomes. Although machine learning models, especially convolutional neural networks (CNNs), have shown great potential in automating melanoma classification, their diagnostic reliability still suffers due to inconsistent focus on lesion areas. In this study, we analyze the relationship between lesion attention and diagnostic performance, involving masked images, bounding box detection, and transfer learning. We used multiple explainability and sensitivity analysis approaches to investigate how well models aligned their attention with lesion areas and how this alignment correlated with precision, recall, and F1-score. Results showed that models with a higher focus on lesion areas achieved better diagnostic performance, suggesting the potential of interpretable AI in medical diagnostics. This study provides a foundation for developing more accurate and trustworthy melanoma classification models in the future.

MedGemma vs GPT-4: Open-Source and Proprietary Zero-shot Medical Disease Classification from Images

Multimodal Large Language Models (LLMs) introduce an emerging paradigm for medical imaging by interpreting scans through the lens of extensive clinical knowledge, offering a transformative approach to disease classification. This study presents a critical comparison between two fundamentally different AI architectures: the specialized open-source agent MedGemma and the proprietary large multimodal model GPT-4 for diagnosing six different diseases. The MedGemma-4b-it model, fine-tuned using Low-Rank Adaptation (LoRA), demonstrated superior diagnostic capability by achieving a mean test accuracy of 80.37% compared to 69.58% for the untuned GPT-4. Furthermore, MedGemma exhibited notably higher sensitivity in high-stakes clinical tasks, such as cancer and pneumonia detection. Quantitative analysis via confusion matrices and classification reports provides comprehensive insights into model performance across all categories. These results emphasize that domain-specific fine-tuning is essential for minimizing hallucinations in clinical implementation, positioning MedGemma as a sophisticated tool for complex, evidence-based medical reasoning.

Agent-Based Output Drift Detection for Breast Cancer Response Prediction in a Multisite Clinical Decision Support System

Modern clinical decision support systems can concurrently serve multiple, independent medical imaging institutions, but their predictive performance may degrade across sites due to variations in patient populations, imaging hardware, and acquisition protocols. Continuous surveillance of predictive model outputs offers a safe and reliable approach for identifying such distributional shifts without ground truth labels. However, most existing methods rely on centralized monitoring of aggregated predictions, overlooking site-specific drift dynamics. We propose an agent-based framework for detecting drift and assessing its severity in multisite clinical AI systems. To evaluate its effectiveness, we simulate a multi-center environment for output-based drift detection, assigning each site a drift monitoring agent that performs batch-wise comparisons of model outputs against a reference distribution. We analyse several multi-center monitoring schemes, that differ in how the reference is obtained (site-specific, global, production-only and adaptive), alongside a centralized baseline. Results on real-world breast cancer imaging data using a pathological complete response prediction model shows that all multi-center schemes outperform centralized monitoring, with F1-score improvements up to 10.3% in drift detection. In the absence of site-specific references, the adaptive scheme performs best, with F1-scores of 74.3% for drift detection and 83.7% for drift severity classification. These findings suggest that adaptive, site-aware agent-based drift monitoring can enhance reliability of multisite clinical decision support systems.

PanopMamba: Vision State Space Modeling for Nuclei Panoptic Segmentation

Nuclei panoptic segmentation supports cancer diagnostics by integrating both semantic and instance segmentation of different cell types to analyze overall tissue structure and individual nuclei in histopathology images. Major challenges include detecting small objects, handling ambiguous boundaries, and addressing class imbalance. To address these issues, we propose PanopMamba, a novel hybrid encoder-decoder architecture that integrates Mamba and Transformer with additional feature-enhanced fusion via state space modeling. We design a multiscale Mamba backbone and a State Space Model (SSM)-based fusion network to enable efficient long-range perception in pyramid features, thereby extending the pure encoder-decoder framework while facilitating information sharing across multiscale features of nuclei. The proposed SSM-based feature-enhanced fusion integrates pyramid feature networks and dynamic feature enhancement across different spatial scales, enhancing the feature representation of densely overlapping nuclei in both semantic and spatial dimensions. To the best of our knowledge, this is the first Mamba-based approach for panoptic segmentation. Additionally, we introduce alternative evaluation metrics, including image-level Panoptic Quality ($i$PQ), boundary-weighted PQ ($w$PQ), and frequency-weighted PQ ($fw$PQ), which are specifically designed to address the unique challenges of nuclei segmentation and thereby mitigate the potential bias inherent in vanilla PQ. Experimental evaluations on two multiclass nuclei segmentation benchmark datasets, MoNuSAC2020 and NuInsSeg, demonstrate the superiority of PanopMamba for nuclei panoptic segmentation over state-of-the-art methods. Consequently, the robustness of PanopMamba is validated across various metrics, while the distinctiveness of PQ variants is also demonstrated. Code is available at https://github.com/mkang315/PanopMamba.

LDP: Parameter-Efficient Fine-Tuning of Multimodal LLM for Medical Report Generation

Colonoscopic polyp diagnosis is pivotal for early colorectal cancer detection, yet traditional automated reporting suffers from inconsistencies and hallucinations due to the scarcity of high-quality multimodal medical data. To bridge this gap, we propose LDP, a novel framework leveraging multimodal large language models (MLLMs) for professional polyp diagnosis report generation. Specifically, we curate MMEndo, a multimodal endoscopic dataset comprising expert-annotated colonoscopy image-text pairs. We fine-tune the Qwen2-VL-7B backbone using Parameter-Efficient Fine-Tuning (LoRA) and align it with clinical standards via Direct Preference Optimization (DPO). Extensive experiments show that our LDP outperforms existing baselines on both automated metrics and rigorous clinical expert evaluations (achieving a Physician Score of 7.2/10), significantly reducing training computational costs by 833x compared to full fine-tuning. The proposed solution offers a scalable, clinically viable path for primary healthcare, with additional validation on the IU-XRay dataset confirming its robustness.

From Future of Work to Future of Workers: Addressing Asymptomatic AI Harms for Dignified Human-AI Interaction

In the future of work discourse, AI is touted as the ultimate productivity amplifier. Yet, beneath the efficiency gains lie subtle erosions of human expertise and agency. This paper shifts focus from the future of work to the future of workers by navigating the AI-as-Amplifier Paradox: AI's dual role as enhancer and eroder, simultaneously strengthening performance while eroding underlying expertise. We present a year-long study on the longitudinal use of AI in a high-stakes workplace among cancer specialists. Initial operational gains hid ``intuition rust'': the gradual dulling of expert judgment. These asymptomatic effects evolved into chronic harms, such as skill atrophy and identity commoditization. Building on these findings, we offer a framework for dignified Human-AI interaction co-constructed with professional knowledge workers facing AI-induced skill erosion without traditional labor protections. The framework operationalizes sociotechnical immunity through dual-purpose mechanisms that serve institutional quality goals while building worker power to detect, contain, and recover from skill erosion, and preserve human identity. Evaluated across healthcare and software engineering, our work takes a foundational step toward dignified human-AI interaction futures by balancing productivity with the preservation of human expertise.

See More, Change Less: Anatomy-Aware Diffusion for Contrast Enhancement

Image enhancement improves visual quality and helps reveal details that are hard to see in the original image. In medical imaging, it can support clinical decision-making, but current models often over-edit. This can distort organs, create false findings, and miss small tumors because these models do not understand anatomy or contrast dynamics. We propose SMILE, an anatomy-aware diffusion model that learns how organs are shaped and how they take up contrast. It enhances only clinically relevant regions while leaving all other areas unchanged. SMILE introduces three key ideas: (1) structure-aware supervision that follows true organ boundaries and contrast patterns; (2) registration-free learning that works directly with unaligned multi-phase CT scans; (3) unified inference that provides fast and consistent enhancement across all contrast phases. Across six external datasets, SMILE outperforms existing methods in image quality (14.2% higher SSIM, 20.6% higher PSNR, 50% better FID) and in clinical usefulness by producing anatomically accurate and diagnostically meaningful images. SMILE also improves cancer detection from non-contrast CT, raising the F1 score by up to 10 percent.