TP-Seg: Task-Prototype Framework for Unified Medical Lesion Segmentation

Universal medical image segmentation seeks to use a single foundational model to handle diverse tasks across multiple imaging modalities. However, existing approaches often rely heavily on manual visual prompts or retrieved reference images, which limits their automation and robustness. In addition, naive joint training across modalities often fails to address large domain shifts. To address these limitations, we propose Concept-to-Pixel (C2P), a novel prompt-free universal segmentation framework. C2P explicitly separates anatomical knowledge into two components: Geometric and Semantic representations. It leverages Multimodal Large Language Models (MLLMs) to distill abstract, high-level medical concepts into learnable Semantic Tokens and introduces explicitly supervised Geometric Tokens to enforce universal physical and structural constraints. These disentangled tokens interact deeply with image features to generate input-specific dynamic kernels for precise mask prediction. Furthermore, we introduce a Geometry-Aware Inference Consensus mechanism, which utilizes the model's predicted geometric constraints to assess prediction reliability and suppress outliers. Extensive experiments and analysis on a unified benchmark comprising eight diverse datasets across seven modalities demonstrate the significant superiority of our jointly trained approach, compared to universe- or single-model approaches. Remarkably, our unified model demonstrates strong generalization, achieving impressive results not only on zero-shot tasks involving unseen cases but also in cross-modal transfers across similar tasks. Code is available at: https://github.com/Yundi218/Concept-to-Pixel

Medical image segmentation foundation models are expected to generalize across diverse clinical scenarios, yet existing universal methods remain fragmented by prompt paradigms and spatial dimensions. Visual in-context learning, interactive segmentation, and language-guided segmentation are typically handled by paradigm-specific models, while 2D and 3D images are also modeled separately. Such isolation prevents heterogeneous annotations and data from being jointly absorbed by a single scalable model and limits cross-paradigm knowledge transfer. To address this bottleneck, we propose UniMedSeg, a Transformer-centric universal segmentation framework that maps visual examples, geometric interactions, language instructions, and 2D/3D images into a shared sequence space, enabling heterogeneous medical supervision to be jointly learned through a unified in-context interface without prompt- or dimension-specific branches. To overcome the long-sequence memory bottleneck caused by visual contexts, we introduce Decoupled Split Attention, which reduces attention complexity to linear while preserving hardware-friendly computation and focused context-target interaction. Extensively trained and evaluated on a large corpus curated from 27 public datasets, UniMedSeg achieves state-of-the-art performance across visual in-context, interactive, and language-guided segmentation without task-specific fine-tuning, demonstrating strong generalization on diverse held-out tasks. The code and model weights are publicly available at https://github.com/Lii1228/UniMedSeg

Accurate lesion segmentation is essential in medical image analysis, yet most existing methods are designed for specific anatomical sites or imaging modalities, limiting their generalizability. Recent vision-language foundation models enable concept-driven segmentation in natural images, offering a promising direction for more flexible medical image analysis. However, concept-prompt-based lesion segmentation, particularly with the latest Segment Anything Model 3 (SAM3), remains underexplored. In this work, we present a systematic evaluation of SAM3 for lesion segmentation. We assess its performance using geometric bounding boxes and concept-based text and image prompts across multiple modalities, including multiparametric MRI, CT, ultrasound, dermoscopy, and endoscopy. To improve robustness, we incorporate additional prior knowledge, such as adjacent-slice predictions, multiparametric information, and prior annotations. We further compare different fine-tuning strategies, including partial module tuning, adapter-based methods, and full-model optimization. Experiments on 13 datasets covering 11 lesion types demonstrate that SAM3 achieves strong cross-modality generalization, reliable concept-driven segmentation, and accurate lesion delineation. These results highlight the potential of concept-based foundation models for scalable and practical medical image segmentation. Code and trained models will be released at: https://github.com/apple1986/lesion-sam3