Understanding Model Behavior in Monocular Polyp Sizing

Progress in colonoscopy polyp segmentation is routinely reported through leaderboard comparisons on a small set of public benchmarks. We argue that this apparent progress is difficult to verify: a systematic audit of \textbf{27 papers} published between 2015 and 2026 reveals three structural problems in how the community evaluates models. \textbf{First}, 25 of 27 papers \textit{omit the Hausdorff distance}. Hausdorff distance is a boundary-accuracy metric with direct clinical relevance for detecting flat or small polyps, and is a standard in radiotherapy segmentation. \textbf{Second}, at least five \textit{incompatible train/test split protocols} co-exist across papers reporting results on the same two datasets (Kvasir-SEG and CVC-ClinicDB), making published Dice scores non-comparable even when they appear in the same leaderboard column. \textbf{Third}, 26 of 27 papers make \textit{performance claims without any statistical significance test}. Strikingly, four papers published \emph{after} the Metrics Reloaded framework~\cite{metricsreloaded2024} (Maier-Hein et al., \textit{Nature Methods} 2024) perpetuate these same problems, suggesting that general-purpose metric guidance has not yet reached the colonoscopy sub-community. To show these problems are not merely cosmetic, we re-evaluate five representative models under three controlled protocols with a single uniform scorer, and find that the reported metric conceals large boundary and recall failures, that the ``best'' model changes with the metric, and that near-tied rankings reverse across random splits. We propose a five-point \textbf{Polyp Segmentation Reporting Checklist}~(PSRC) as a lightweight, domain-adapted corrective.

Accurate polyp segmentation in colonoscopy is essential for early colorectal cancer detection, yet real-world clinical environments pose persistent challenges such as motion blur, specular reflections, and illumination instability. Most existing methods are optimized on clean benchmark images and suffer noticeable performance degradation when deployed in authentic surgical scenarios. We propose DepthPolyp, a lightweight and robust segmentation framework based on pseudo-depth-guided multi-task learning and efficient feature modulation. The architecture combines hierarchical Ghost factorization for compact feature generation, Interleaved Shuffle Fusion for low-cost cross-scale interaction, and Dynamic Group Gating for adaptive group-wise feature weighting. Extensive experiments demonstrate that DepthPolyp achieves strong cross-dataset generalization when trained on degraded data and evaluated on both clean and noisy target domains, consistently outperforming lightweight baselines and remaining competitive with substantially larger models. In real surgical video evaluation on PolypGen, DepthPolyp achieves better segmentation performance than models up to $20\times$ larger while preserving real-time inference speed. With only 3.57M parameters and 0.86 GMACs, the proposed method runs at over 180 FPS on mobile devices, making it well suited for real-time deployment in resource-constrained clinical environments. Code and pretrained weights are available at: https://github.com/ReaganWu/DepthPolyp/

In real-time colonoscopy, ground-truth annotations are unavailable at inference, so polyp segmentation models can fail silently. We propose Referee-Based Quality Estimation (RBQE), a reference-free framework measuring agreement between a primary segmentation model and an independently trained referee on the same image. RBQE is evaluated on a standardized 1,223-image external benchmark drawn from four public datasets, using four referee configurations chosen to separate two design axes: referee independence and architectural diversity. Using a common Agreement Dice descriptor, a same-architecture referee differing from the primary model only in random initialization already yields a useful reliability signal (ROC-AUC = 0.923), showing that independent training alone is sufficient. Cross-architecture referees improve further: SegFormer-B0 achieves the strongest performance (ROC-AUC = 0.960), significantly outperforming the same-architecture control and UNet++, and exceeding a representative Test-Time Augmentation baseline by 0.055 ROC-AUC under an identical protocol, whereas a prompt-coupled MedSAM referee underperforms despite maximal architectural diversity. Because empty-mask agreement is trivially separable, we also report a restricted evaluation excluding such cases: ROC-AUC falls to 0.876 (SegFormer-B0, 1,046 images) and 0.783 (same-architecture control, 975 images), yet RBQE's margin over both baselines widens on this identical subset. RBQE additionally increases the mean Dice of retained predictions as low-agreement cases are progressively rejected, supporting selective prediction, and requires only one additional deterministic referee forward pass at inference. Our study therefore supports cross-model agreement as a practical, interpretable reliability framework for automated polyp segmentation.