Distance-based reliability estimation assumes that a representation's geometry reflects its trustworthiness, yet this assumption is rarely tested under training interventions that reshape geometry directly. We audit this assumption under domain-adversarial representation learning using a disentanglement dose-response ladder. Three checkpoint families share the same architecture and a 16-dimensional representation, differing only in orthogonality strength (lambda = 0, 1, 5). Representation geometry changed substantially with disentanglement strength: the condition number shifted by two orders of magnitude (Kendall tau = 0.84, exact p = 2.8e-5). This change was not accompanied by improved reliability estimation: Mahalanobis-distance AUROC (ISIC-test vs. PAD-UFES) remained flat and below chance (about 0.40) at every level, with no significant association with any of five geometry metrics tested. The same failure was observed for cosine-to-centroid and pooled k-nearest-neighbor scorers, plus three non-distance-based scorers: an energy-based confidence score, Virtual-Logit Matching, and a kernel density estimator. Seven of eight scorers converged on the same result; the energy-based score showed an isolated upward trend that we report but do not treat as evidence against the overall pattern. A supervised probe with no access to the training objective recovered domain membership from the identical embeddings at 0.72-0.81 AUROC across every level, showing that the relevant information was not absent from the representation. These findings indicate that classification performance alone can overlook whether information in a learned representation is organized in a form that downstream reliability estimators can use. Information can remain decodable while becoming largely inaccessible to non-probing reliability estimators.
Jingjun Gu, Chaojie Shen, Yifeng Cao +3eess.IV cs.AI cs.CV
Skin lesion segmentation is a key task in computer-aided dermatological diagnosis, where accuracy directly impacts downstream analysis and disease classification. However, dermoscopic images are challenging due to blurred boundaries, low contrast, large shape variations, and artifacts such as hair and shadows. Recently, diffusion models have shown strong performance in medical image segmentation thanks to their progressive denoising and distribution modeling capabilities. Nevertheless, existing diffusion-based methods still suffer from limited cross-level feature interaction and insufficient boundary detail recovery. To address these issues, we propose MLFFM-SegDiff, a multi-level feature fusion diffusion model for skin lesion segmentation. Built on a diffusion framework, the method introduces a dual-path U-Net encoder, a Multi-Level Feature Fusion Module (MLFFM), and a boundary-sensitive loss function. The dual-path encoder enhances interaction between noisy mask features and dermoscopic image features. MLFFM improves skip connections via attention, scale alignment, and adaptive cross-level fusion. These designs enable the decoder to jointly leverage shallow boundary cues and deep semantic representations, improving mask reconstruction quality. Experiments on ISIC2018, PH2, and HAM10000 demonstrate that MLFFM-SegDiff outperforms representative methods including DermoSegDiff, U-Net, and SwinUNETR across Accuracy, F1-score, Jaccard index, Recall, and Dice. In particular, it achieves an average Jaccard index of 0.8546 and Dice coefficient of 0.9207. These results validate the effectiveness of the proposed multi-level feature fusion strategy for improving lesion segmentation performance. The code will be released at https://github.com/Qacket/MLFFM-SegDiff.git after publication.
Asad Channa, Abdullah Khan, Asghar Ali Chandio +4cs.CV
Automated segmentation of skin lesions using deep learning models for dermoscopic images can be very helpful in finding melanomas earlier than they would normally be detected. However, most deep learning methods available do not perform well. The aim of this paper is to present a parameter-efficient fine-tuning method called PEFT-MedSAM for adapting the Medical Segment Anything Model (MedSAM) to automatically segment dermoscopic skin lesions. The PEFT-MedSAM method uses only the lightweight mask decoder for training the model while keeping the pre-trained image encoder and prompt encoder frozen. The experiments performed on the ISIC 2018 benchmark dataset shows that PEFT-MedSAM obtains a dice coefficient of .9411 and an intersection over union value of .8918 when compared to both a fully trained U-Net baseline (.8715 dice coefficient) and zero-shot MedSAM inference (.8997 dice coefficient). The external validation of the model using PH2 dataset shows .9467 dice coefficient with +/- .0310 standard deviation. Supportive evidence for these claims include a p-value less than .0001 for Wilcoxon signed rank tests comparing the two datasets and bootstrap-estimated 95% confidence intervals of [.9364,.9447] that represent the estimated range of possible values for the average dice coefficient obtained by repeating the test. To increase clinical trustworthiness, we used Grad-CAM explainability along with a pointing game based evaluation methodology to evaluate the CNN baseline model on the validation set. The results showed that we had an accuracy rate of 98.27% on the validation set of 519 images and confirmed that the model classified regions containing skin lesions.