Disentangling Sampling from Training Budget in Class-Imbalanced CT Body Composition Segmentation

Real-world datasets often exhibit long-tailed class distributions, where a few head classes contain a large number of training samples while a large number of tail classes have only a few. The composition of each mini-batch, determined by the sampling strategy, governs which classes contribute to the stochastic gradient estimate, and therefore affects convergence behaviour and generalisation across the whole class spectrum. We provide a systematic theoretical and empirical comparison of four mini-batch sampling strategies for long-tailed image classification: uniform instance sampling, class-balanced sampling, square-root sampling, and progressively balanced sampling. We place all four in a unified bias-variance framework describing their effect on gradient estimation, which exposes the tension between unbiased optimisation of the empirical loss and fair representation of rare classes. We then evaluate them under controlled conditions using ResNet-32 on CIFAR-100-LT at three imbalance ratios (rho = 10, 50, 100), with every strategy sharing the same long-tailed subsets and initialisation within a seed. Progressive sampling improves tail-class accuracy by 25% relative to the uniform baseline at rho = 100 (13.5% versus 10.8%), consistently across all three seeds, while its overall accuracy is not distinguishable from that of uniform sampling given the seed-to-seed variation (40.0% versus 39.7%); the tail-class gain, not the overall gain, is the robust effect. At rho = 100, class-balanced sampling degrades accuracy on every class group, including the tail classes it is designed to help, which we attribute to overfitting caused by extreme oversampling of scarce data; at rho = 50 this failure is confined to head and medium classes. These results indicate that when rebalancing is applied during training matters as much as how much rebalancing is applied.

Instance-sensitive losses for semantic segmentation such as blob loss and CC loss were designed to address instance imbalance, ensuring small lesions generate the same gradient as large ones, but operate only on single-class segmentation. In multi-class settings, class imbalance poses an additional problem: rare classes with few instances receive a disproportionately small share of the training signal. We show that extending instance-sensitive losses to multi-class segmentation via a one-vs-rest class decomposition repurposes them to also address class imbalance, as uniform averaging over classes ensures each class contributes equally regardless of frequency. We further show that inverse-size weighting, which destabilizes training when applied globally due to weight imbalances across rare and common classes, becomes effective when integrated within the per-component loss, confining the reweighting to each component's spatial context. On the BraTS-METS 2025 dataset (260 test cases), multi-class CC loss improves foreground Dice (0.64 +/- 0.26 vs. 0.59 +/- 0.27 baseline) and rare-class Dice, while maintaining Panoptic Quality at DSC threshold 0.5. Multi-class blob loss achieves the best Panoptic Quality at threshold 0.5 (0.40 +/- 0.24 vs. 0.38 +/- 0.25 baseline) and recognition quality (0.53 +/- 0.29 vs. 0.49 +/- 0.30). Integrating inverse-size weighting within the per-component loss increases rare-class Dice to 0.44 +/- 0.36 at the cost of reduced detection quality.

Precise medical image segmentation is crucial for clinical diagnosis and treatment planning, yet relies heavily on expensive expert annotations. Semi-supervised medical image segmentation (SSMIS) offers a cost-effective solution but typically operates under the assumption of independent and identically distributed (i.i.d.) data, defaulting to random sampling. While statistically valid at scale, this strategy suffers from severe representation bias in low-data regimes, failing to capture the heterogeneous medical data manifold. To address this, we propose a highly data-efficient framework driven by distribution alignment. First, we introduce an offline Distribution-Aware Sample Selection strategy. By leveraging Vision Foundation Models (VFMs) and our designed Density-K-Center algorithm, we explicitly identify representative structural anchors, establishing a more representative labeled domain. Second, to bridge the remaining distribution gap, we propose the Memory-guided Copy-Paste (MCP) module. Tailored for the inherent class imbalance in medical scans, MCP leverages a semantic memory mechanism to retrieve historically consistent priors for cross-domain alignment, encouraging semantic consistency. Coupled with an easy-to-hard progressive schedule, this framework effectively mitigates early-stage pseudo-label noise. Extensive experiments on six diverse 2D and 3D datasets demonstrate strong segmentation performance, particularly in extremely low-labeled scenarios (\eg, 1/16 ratio).