Organizations: Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan · State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou 510060, China · Southeast University, School of Cyber Science and Engineering Nanjing, Jiangsu, China · School of Software Technology, Zhejiang University, Ningbo 315100, China · Advanced Institute of Convergence Knowledge Informatics, Research Institute of Electrical Communication, Tohoku University, Sendai 980-0812, Japan · National Institute of Technology, Sendai College, Sendai 989-3128, Japan · Department of Mathematics, Informatics, and Cybernetics, University of Chemistry and Technology, Prague, Czech Republic
Semi-supervised learning (SSL) has emerged as a promising paradigm for breast ultrasound (BUS) image segmentation, but it often suffers from unstable pseudo labels under extremely limited annotations, leading to inaccurate supervision and degraded performance. Recent vision-language models (VLMs) provide a new opportunity for pseudo-label generation, yet their effectiveness on BUS images remains limited because domain-specific prompts are difficult to transfer. To address this issue, we propose a semi-supervised framework with training-free pseudo-label generation and label refinement. By leveraging simple appearance-based descriptions (e.g., dark oval), our method enables cross-domain structural transfer between natural and medical images, allowing VLMs to generate structurally consistent pseudo labels. These pseudo labels are used to warm up a static teacher that captures global structural priors of breast lesions. Combined with an exponential moving average teacher, we further introduce uncertainty entropy weighted fusion and adaptive uncertainty-guided reverse contrastive learning to improve boundary discrimination. Experiments on four BUS datasets demonstrate that our method achieves performance comparable to fully supervised models even with only 2.5% labeled data, significantly outperforming existing SSL approaches. Moreover, the proposed paradigm is readily extensible: for other imaging modalities or diseases, only a global appearance description is required to obtain reliable pseudo supervision, enabling scalable semi-supervised medical image segmentation under limited annotations.
Figures & tables
Fig. 1: To illustrate how different textual prompts affect zero-shot knowledge transfer, we visualize bounding box generated from (c) medical terms (“tumor”), (d) radiological attributes (“high density”), and (e) appearance-based descriptions(“dark oval.dark round.dark lobulated”).
Fig. 2: Overview of the proposed semi-supervised BUS segmentation framework. The pipeline consists of two stages: (1) Appearance-Prompted Pseudo-Label Generation (APPG), where appearance-prompted vision–language models (VLMs) produce initial pseudo labels in a training-free manner; (2) Pseudo-Label Refinement, which includes two steps: static-teacher warm-up training to capture coarse structural priors of breast lesions, and uncertainty-based semi-supervised learning using a dual-teacher framework with Uncertainty–Entropy Weighted Fusion (UEWF) and Adaptive Uncertainty-Guided Reverse Contrastive Learning (AURCL).
Fig. 3: Structure of the proposed AURCL module. Entropy maps identify top- k high-uncertainty pixels, whose predictions are reversed and aggregated into patch-level features. Contrastive learning then pulls the original and reversed high-entropy features from these high-entropy patches closer to each other, while pushing them apart from stable low-entropy patches.
Fig. 4: Visual comparison of different state-of-the-art methods on the BUSI and UBB datasets. All models are trained in 2.5% labeled data. Red, green and yellow regions represent ground truth, prediction and overlapping regions, respectively.
Method
Venue
BUSI
UBB (UDIAT + BREASTUSG + BUSUCLM)
Labeled
Unlabeled
Dice(%) ↑
IoU(%) ↑
Acc(%) ↑
Labeled
Unlabeled
Dice(%) ↑
IoU(%) ↑
Acc(%) ↑
U-Net (static teacher)
–
0
499
67.34
57.28
93.03
0
474
69.95
60.26
96.67
U-Net
MICCAI
12 (2.5%)
0
50.00
39.71
92.35
13 (2.5%)
0
43.52
31.03
93.52
U-Net
MICCAI
51 (10%)
0
65.04
54.77
94.76
54 (10%)
0
67.39
55.76
96.75
U-Net
MICCAI
103 (20%)
0
70.94
61.79
95.06
108 (20%)
0
67.95
58.22
96.93
U-Net
MICCAI
517 (100%)
0
81.68
73.74
96.65
542 (100%)
0
74.81
65.56
97.29
TABLE I: Comparison of segmentation performance on BUSI and UBB (UDIAT + BREASTUSG + BUSUCLM) datasets under different labeling ratios.
Method
APPG
UEWF
AURCL
Dice(%)
IoU(%)
SupOnly
50.00
39.71
I
✓
54.09
42.93
III
✓
71.17
61.63
IIII
✓
✓
71.64
62.49
IIIII
✓
✓
72.16
62.56
IIIIII
✓
✓
✓
72.72
63.11
TABLE II: Ablation study of different components on BUSI dataset under 2.5% partition protocol. “SupOnly” stands for training using only labeled data.
Fig. 5: Visual comparison of different ablation study on the BUSI and UBB datasets. All models are trained in 2.5% labeled data. Red, green and yellow regions represent ground truth, prediction and overlapping regions, respectively. (a) image, (b) ground truth, (c) APPG (step1), (d) STWP (step 2), (e) Ours
Method
Dice (%)
IoU (%)
w/o Patchify
71.89
62.52
w/ Patchify
72.72
63.11
TABLE III: Ablation study on the effectiveness of the patchify in UEWF under 2.5% partition protocol.
τ
Dice (%)
IoU (%)
60
71.81
62.35
40
71.96
62.45
20
72.72
63.11
TABLE IV: Ablation study on the confidence threshold τ in the AURCL module under 2.5% partition protocol.
Fig. 6: Visual comparison of zero-shot bounding boxes and pseudo masks under different prompt conditions. (a) Bounding boxes generated using the medical term “tumor” ; (b) bounding boxes generated using the medical term “lesion” ; (c) bounding boxes generated using the medical term “breast cancer” ; (d) bounding boxes generated using the radiology term “high density” ; (e) bounding boxes produced by our proposed “Appearance-prompted training-free pseudo label generation” strategy; Overlap denotes pseudo masks generated by applying SAM to the bounding boxes from our strategy, and the overlapping regions with GT.
Method
Venue
BUSI
UBB
Dice(%)
IoU(%)
Dice(%)
IoU(%)
MediClipV2
MedIA’25
28.74
22.08
23.87
18.55
UniversalSeg
ICCV’23
30.68
21.99
48.17
35.77
GroundingDino(SFT)
ECCV’24
44.14
33.09
49.67
36.40
Ours
–
72.72
63.11
75.75
65.86
TABLE V: Comparison with VLM-based few-shot methods on BUSI and UBB under the 2.5% labeled partition protocol. All methods use 2.5% ground-truth labels for few-shot setting.
Fig. 7: Qualitative results on multiple datasets and imaging modalities to demonstrate the generalizability of our APPG pipeline. (a) skin lesion (dermoscopy), (b) thyroid nodule/tumor (ultrasound), (c) colorectal polyp (endoscopy), and (d) ovarian lesion (ultrasound).
Medical ultrasound image segmentation faces significant challenges due to limited labeled data and characteristic imaging artifacts including speckle noise and low-contrast boundaries. While semi-supervised learning (SSL) approaches have emerged to address data scarcity, existing methods suffer from suboptimal unlabeled data utilization and lack robust feature representation mechanisms. In this paper, we propose Switch, a novel SSL framework with two key innovations: (1) Multiscale Switch (MSS) strategy that employs hierarchical patch mixing to achieve uniform spatial coverage; (2) Frequency Domain Switch (FDS) with contrastive learning that performs amplitude switching in Fourier space for robust feature representations. Our framework integrates these components within a teacher-student architecture to effectively leverage both labeled and unlabeled data. Comprehensive evaluation across six diverse ultrasound datasets (lymph nodes, breast lesions, thyroid nodules, and prostate) demonstrates consistent superiority over state-of-the-art methods. At 5% labeling ratio, Switch achieves remarkable improvements: 80.04% Dice on LN-INT, 85.52% Dice on DDTI, and 83.48% Dice on Prostate datasets, with our semi-supervised approach even exceeding fully supervised baselines. The method maintains parameter efficiency (1.8M parameters) while delivering superior performance, validating its effectiveness for resource-constrained medical imaging applications. The source code is publicly available at https://github.com/jinggqu/Switch
Jingguo Qu, Xinyang Han, Yao Pu +8
Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, China · Centre for Smart Health and School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China · Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China
In the era of information explosion, efficiently leveraging large-scale unlabeled data while minimizing the reliance on high-quality pixel-level annotations remains a critical challenge in the field of medical imaging. Semi-supervised learning (SSL) enhances the utilization of unlabeled data by facilitating knowledge transfer, significantly improving the performance of fully supervised models and emerging as a highly promising research direction in medical image analysis. Inspired by the ability of Vision Foundation Models (e.g., SAM-2) to provide rich prior knowledge, we propose SSS (Semi-Supervised SAM-2), a novel approach that leverages SAM-2's robust feature extraction capabilities to uncover latent knowledge in unlabeled medical images, thus effectively enhancing feature support for fully supervised medical image segmentation. Specifically, building upon the single-stream "weak-to-strong" consistency regularization framework, this paper introduces a Discriminative Feature Enhancement (DFE) mechanism to further explore the feature discrepancies introduced by various data augmentation strategies across multiple views. By leveraging feature similarity and dissimilarity across multi-scale augmentation techniques, the method reconstructs and models the features, thereby effectively optimizing the salient regions. Furthermore, a prompt generator is developed that integrates Physical Constraints with a Sliding Window (PCSW) mechanism to generate input prompts for unlabeled data, fulfilling SAM-2's requirement for additional prompts. Extensive experiments demonstrate the superiority of the proposed method for semi-supervised medical image segmentation on two multi-label datasets, i.e., ACDC and BHSD. Notably, SSS achieves an average Dice score of 53.15 on BHSD, surpassing the previous state-of-the-art method by +3.65 Dice. Code will be available at https://github.com/AIGeeksGroup/SSS.
We propose a hybrid diffusion-based augmentation framework to overcome the critical challenge of ultrasound data augmentation in breast ultrasound (BUS) datasets. Unlike conventional diffusion-based augmentations, our approach improves visual fidelity and preserves ultrasound texture by combining text-to-image generation with image-to-image (img2img) refinement, as well as fine-tuning with low-rank adaptation (LoRA) and textual inversion (TI). Our method generated realistic, class-consistent images on an open-source Kaggle breast ultrasound image dataset (BUSI). Compared to the Stable Diffusion v1.5 baseline, incorporating TI and img2img refinement reduced the Frechet Inception Distance (FID) from 45.97 to 33.29, demonstrating a substantial gain in fidelity while maintaining comparable downstream classification performance. Overall, the proposed framework effectively mitigates the low-fidelity limitations of synthetic ultrasound images and enhances the quality of augmentation for robust diagnostic modeling.
Farhan Fuad Abir, Sanjeda Sara Jennifer, Niloofar Yousefi +1
Electrical and Computer Engineering, University of Central Florida · Department of Medicine, University of Central Florida College of Medicine · Department of Computer Science, University of Central Florida +1