OTCHA: Optimal Transport-driven Confidence-aware Latent Hub Alignment for Multi-View Medical Image Classification

Accurate breast cancer classification from mammography requires effective integration of complementary information from craniocaudal (CC) and mediolateral oblique (MLO) views, which provide a more complete characterization of breast abnormalities. However, existing multi-view learning approaches typically rely on feature-level aggregation or single-stage cross-attention, which can entangle view-specific and shared representations and restrict interaction to limited network depths. To address these limitations, we propose a token-centric dual-view learning framework that unifies prompt-based adaptation and cross-view fusion within a frozen vision transformer backbone. The framework reformulates inter-view interaction as structured token-level communication, where dedicated fusion tokens explicitly encode bidirectional information exchange between CC and MLO views via cross-attention, serving as intermediate carriers of cross-view dependencies rather than relying on direct feature fusion. Unlike conventional methods that apply fusion at a single layer, fusion modules are inserted at multiple transformer depths, enabling progressive and repeated interaction across the encoder hierarchy. Fusion tokens are reintegrated into the token sequence and refined by subsequent transformer layers, facilitating hierarchical propagation of complementary information while preserving view-specific structure. Experiments on VinDr-Mammo and CMMD datasets demonstrate consistent improvements over linear probing, prompt-only adaptation, and conventional fusion baselines. On the VinDr-Mammo BI-RADS classification task, the framework achieves 50.40% F1-score and 0.8090 AUC, including a 0.10 AUC improvement over a dual-view fusion baseline in the binary setting. Ablation studies further validate the effectiveness of token-based fusion and multi-depth interaction design.

Fine-grained medical image classification is challenged by subtle inter-class variations and visually ambiguous cases, where confidence estimates often exhibit uncertainty rather than being overconfident. In such scenarios, purely discriminative classifiers may achieve high overall accuracy yet still fail to distinguish between highly similar categories, leading to miscalibrated predictions. We propose T-DuMpRa, a teacher-guided dual-path multi-prototype retrieval-augmented framework, where discriminative classification and multi-prototype retrieval jointly drive both training and prediction. During training, we jointly optimize cross-entropy and supervised contrastive objectives to learn a cosine-compatible embedding geometry for reliable prototype matching. We further employ an exponential moving average (EMA) teacher to obtain smoother representations and build a multi-prototype memory bank by clustering teacher embeddings in the teacher embedding space. Our framework is plug-and-play: it can be easily integrated into existing classification models by constructing a compact prototype bank, thereby improving performance on visually ambiguous cases. At inference, we combine the classifier's predicted distribution with a similarity-based distribution computed via cosine matching to prototypes, and apply a conservative confidence-gated fusion that activates retrieval only when the classifier's prediction is uncertain and the retrieval evidence is decisive and conflicting, otherwise keeping confident predictions unchanged. On HAM10000 and ISIC2019, our method yields 0.68%-0.21% and 0.44%-2.69% improvements on 5 different backbones. And visualization analysis proves our model can enhance the model's ability to handle visually ambiguous cases.

Cross-modal alignment of visual and textual representations is fundamental to multimodal medical image understanding, yet remains hindered by uncertainty in both modalities under real-world clinical conditions. Existing vision-language segmentation methods rely on deterministic cross-modal matching, which overlooks aleatoric uncertainty from ambiguous boundaries and epistemic uncertainty from limited training data, leading to fragile performance under domain shift. To address this issue, we propose DistMedVL, a probabilistic vision-language framework that introduces a lightweight Probabilistic Cross-Modal Adapter (PCM-Adapter) upon frozen encoders to explicitly model representational uncertainty. Specifically, the PCM-Adapter comprises two sequential modules for progressive probabilistic alignment. We first devise a Mahalanobis Alignment Module (MAM) that models textual tokens as Gaussian distributions and computes patch-text compatibility via Mahalanobis distance, yielding variance-conditioned matching that downweights unreliable feature dimensions. Moreover, we devise a Distribution Flow Module (DFM) that estimates modality-wise confidence parameters and performs vision-guided refinement of textual distributions, accommodating distributional variation across imaging modalities. Extensive experiments across eight medical segmentation benchmarks demonstrate that DistMedVL outperforms state-of-the-art methods with only 6.3M trainable parameters, exhibiting superior data efficiency, perturbation robustness and cross-dataset generalization.