We conducted a reproducibility-oriented re-evaluation of prior migraine classification studies, correcting for data leakage and metric bias. We then introduced (i) a clinically motivated aggregation of two hemiplegic subtypes following ICHD-3 §1.2.3, (ii) a class-dependent hybrid augmentation strategy that assigns generation methods based on per-class sample size, and (iii) the concept of fidelity asymmetry, motivating proportionally constrained growth as an alternative to full class balance. Experiments were performed on a dataset of 400 patients across seven migraine subtypes under a two-stage protocol, including the six-class configuration described above. Models were evaluated using stratified 5-fold cross-validation with macro-averaged F1 as the primary metric. Correcting methodological flaws reduces previously inflated performance estimates, with the corrected macro-F1 baseline standing at 0.71. The proposed framework consistently outperformed individual augmenters in macro-F1 averaged across the eight evaluated classifiers (0.862 vs. 0.836 for Gaussian Copula, 0.815 for CTGAN, and 0.801 for the no-augmentation baseline), and achieved its peak result of 0.914 with FT-Transformer under proportional augmentation. The no-augmentation FT-Transformer baseline (0.896) shows that, at the per-classifier ceiling, clinically motivated class aggregation accounts for most of the absolute improvement; the framework's principal measurable contribution is the gain in average robustness across classifiers, highlighting the dominant role of problem formulation.
Generative augmentation is often proposed as a remedy for small medical-image datasets, but synthetic images are only useful when they improve downstream task performance. "Augmentation" here means synthetic supplementation: GAN-generated samples added to the real training pool, not geometric or photometric transforms of existing images. Twelve class-plane StyleGAN2-ADA generators were trained on constrained BRISC 2025 partitions to test whether their output, with or without InceptionV3 feature-space filtering, improves held-out tumour classification across three classifier families: a random forest (RF) on InceptionV3 features, a compact two-headed convolutional neural network (CNN), and MobileViTV2, a mobile hybrid convolutional-transformer. Each was evaluated at 1:1 and 1:2 real-to-synthetic ratios. An independent GPT-5.5 blind test placed gated real-versus-synthetic discrimination at 57.73% (95% CI: 54.48--60.92%) on the model-legible subset -- modestly above chance. The RF classifier did not benefit from the synthetic MRIs. The CNN showed consistent mean gains that did not survive Holm correction. MobileViTV2 showed the clearest benefit: filtered 1:1 augmentation improved tumour classification accuracy by 1.02% absolute (95% CI: 0.54--1.54%; Holm-corrected p = 0.0104). A secondary efficiency analysis found that every augmented CNN condition selected its checkpoint 42--64% earlier than baseline, while compute-matched MobileViTV2 runs reached selection after 50--67% fewer real-data epochs. Overall, augmentation utility was found to be architecture- and ratio-dependent, not guaranteed by visual fidelity alone.
Rare diseases dominate the diagnostic challenge in medical imaging yet are severely underrepresented in clinical datasets, causing classifiers to fail on exactly the conditions where reliable detection matters most. Generative augmentation can supply the missing tail-class coverage, but coarse disease labels aggregate diverse subtypes and acquisition settings into multi-modal conditionals that bias generators toward dominant submodes, while a shared Gaussian source forces rare subpopulations through disproportionately long transport paths. We propose an offline strategy that introduces informative priors at two levels: first, we partition each coarse label into coherent submodes via Gaussian mixture modeling in the generative model's latent space; second, we learn subclass-conditioned source distributions that re-center and re-scale the starting distribution per submode, shortening trajectories and reducing within-subclass dispersion. To prevent degenerate solutions we impose explicit geometric control, moderately concentrating normalized displacement directions around learnable prototypes while capping path-length outliers. On long-tailed chest X-ray (MIMIC-LT, NIH-LT) and CT slice (CT-RATE) benchmarks the proposed method consistently improves tail-class generation fidelity and diversity (FID, IRS) and is a promising augmentation strategy that reliably improves downstream balanced accuracy and macro-F1 over a non-augmented baseline across modalities.
Synthetic data augmentation is widely used to mitigate class imbalance, but its theoretical effects on score-based classification remain poorly understood. This paper develops a framework for characterizing when synthetic minority augmentation can improve threshold-integrated and threshold-optimized metrics, including AUROC, AUPRC, best-threshold balanced accuracy, and best-threshold \F1 score. We separate the effect of augmentation into two components: a change in effective class weighting and a discrepancy between the synthetic and true minority distributions. Under well-specified score models, the raw estimator already targets the likelihood-ratio ordering, which is population-optimal for the metrics considered. Consequently, augmentation cannot provide a fundamental population-level improvement beyond possible finite-sample variance reduction, and may introduce additional bias through synthetic distributional error. We further establish minimax lower bounds showing that the raw estimator already achieves the optimal metric-regret rate in the well-specified regime. Under misspecification, however, augmentation can play a qualitatively different role: by changing the effective class balance, it can alter the restricted-class projection and correct ranking errors induced by the raw imbalanced objective. We provide explicit improvement bounds quantifying the roles of approximation error, finite-sample estimation error, and synthetic distributional error. Simulation studies corroborate the theory, demonstrating limited gains under well-specification and nontrivial but nonmonotone improvements under misspecification.