Contrastive Learning under Noisy Temporal Self-Supervision for Colonoscopy Videos
Authors: Luca Parolari, Pietro Gori, Lamberto Ballan, Carlo Biffi, Loic Le Folgoc
Organizations: Department of Mathematics, University of Padova, Padova, Italy · LTCI, Telecom Paris, Institut Polytechnique de Paris, Palaiseau, France · Cosmo Intelligent Medical Devices, Dublin, Ireland
Abstract
Learning robust representations of polyp tracklets is key to enabling multiple AI-assisted colonoscopy applications, from polyp characterization to automated reporting and retrieval. Supervised contrastive learning is an effective approach for learning such representations, but it typically relies on correct positive and negative definitions. Collecting these labels requires linking tracklets that depict the same underlying polyp entity throughout the video, which is costly and demands specialized clinical expertise. In this work, we leverage the sequential workflow of colonoscopy procedures to derive self-supervised associations from temporal structure. Since temporally derived associations are not guaranteed to be correct, we introduce a noise-aware contrastive loss to account for noisy associations. We demonstrate the effectiveness of the learned representations across multiple downstream tasks, including polyp retrieval and re-identification, size estimation, and histology classification. Our method outperforms prior self-supervised and supervised baselines, and matches or exceeds recent foundation models across all tasks, using a lightweight encoder trained on only 27 videos. Code is available at https://github.com/lparolari/ntssl.
Because dense frame-level annotation of colonoscopy videos is costly, we propose WSPolypNet, a weakly supervised framework for polyp localization using only video-level labels. WSPolypNet employs a 3D convolutional neural network trained with video-level supervision to generate class activation maps (CAMs), which identify candidate polyp regions without requiring frame-level spatial annotations. The CAM-derived localization cues are further enhanced using a multi-view strategy and provided to MedSAM2 as point prompts. MedSAM2 then propagates segmentation masks across the video, refining the coarse localization cues according to polyp boundaries. WSPolypNet achieved CorLoc scores of 47.80%, 43.68%, and 35.01% at IoU thresholds of 0.3, 0.5, and 0.7, respectively, compared with 36.87%, 33.72%, and 27.94% in the single-view setting. For small polyps, the multi-view strategy improved CorLoc@0.5 from 16.01% to 30.97%. The framework also achieved a recall of 94.51%. These results demonstrate the potential of weakly supervised spatiotemporal learning to substantially reduce spatial annotation requirements for polyp localization in colonoscopy videos.
Colo-segment recognition in colonoscopy videos is a key requirement for many downstream tasks, but existing automatic recognition methods only use colonoscopy images without fully exploiting the use of temporal information, leading to poor performance. Additionally, relevant public video-based datasets are in scarcity. To tackle this problem, we curate and release a labeled dataset specifically for the task of colo-segment recognition. In addition, we propose a two-stage deep learning-based framework, Colo-Segment Recognition via SpatioTemporal Network (ST-ColoNet), for the task of colo-segment recognition from colonoscopy videos which includes the Colorlaus module that uses metric learning to optimize edge-mediated spatial feature extraction, as well as the Full-Temp module which combines three self-attention patterns to better approximate full self-attention on long colonoscopy sequences and optimize temporal feature aggregation. Through extensive ablation experiments, we show that our framework is capable of achieving state-of-the-art performance on the task of colo-segment recognition, achieving an accuracy of 81.0% and F1-score of 70.7%, which is a tremendous improvement over state-of-the-art methods.
Early screening via colonoscopy is critical for colon cancer prevention, yet developing robust AI systems for this domain is hindered by the lack of densely annotated, long-sequence video datasets. Existing datasets predominantly focus on single-class polyp detection and lack the rich spatial, temporal, and linguistic annotations required to evaluate modern Multimodal Large Language Models (MLLMs). To address this critical gap, we introduce Colon-Bench, generated via a novel multi-stage agentic workflow. Our pipeline seamlessly integrates temporal proposals, bounding-box tracking, AI-driven visual confirmation, and human-in-the-loop review to scalably annotate full-procedure videos. The resulting verified benchmark is unprecedented in scope, encompassing 528 videos, 14 distinct lesion categories (including polyps, ulcers, and bleeding), over 300,000 bounding boxes, 213,000 segmentation masks, and 133,000 words of clinical descriptions. We utilize Colon-Bench to rigorously evaluate state-of-the-art MLLMs across lesion classification, Open-Vocabulary Video Object Segmentation (OV-VOS), and video Visual Question Answering (VQA). The MLLM results demonstrate surprisingly high localization performance in medical domains compared to SAM-3. Finally, we analyze common VQA errors from MLLMs to introduce a novel "colon-skill" prompting strategy, improving zero-shot MLLM performance by up to 9.7% across most MLLMs. The dataset and the code are available at https://abdullahamdi.com/colon-bench .