Metrics or Mirage? An Audit of Evaluation Inconsistencies in Colonoscopy Polyp Segmentation Benchmarks

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.

Accurate polyp size stratification guides surveillance decisions, with lesions larger than 5 mm typically requiring closer follow-up. However, monocular colonoscopy lacks a reliable metric reference. We present a diagnostic audit of binary polyp size classification (<=5 mm vs. >5 mm) across multiple public multi-center datasets, model families, and patient-stratified cross-validation. Across architectures and input modalities, including RGB appearance, relative depth, and photometry, model performance is moderately consistent, suggesting reliance on cues correlated with examination behavior rather than true metric scales. By providing ground-truth scale at varying granularities, we quantify the potential improvement from perfect scale information and show that current depth estimation and global calibration offer limited gains. We further demonstrate that segmentation errors under distribution shift eliminate most of this potential, with oracle scale under predicted masks recovering only baseline performance. These results highlight metric scale and mask robustness as two independent bottlenecks and provide reusable evaluation tools such as oracle scale ladders, shortcut partitions, and mask substitution for auditing future polyp sizing pipelines. Our code is publicly accessible at https://github.com/anaxqx/polyp-sizing-audit.

Post-refinement can improve colonoscopy segmentation after host inference, but many designs still rely on extra correction heads or multi-stage pipelines with non-negligible parameter or computational cost. For polyp segmentation, host predictions are often already reasonable globally, with remaining errors clustered around ambiguous boundaries and difficult local structures. These residual errors matter in colonoscopy images because useful masks need correct lesion coverage and clean contour delineation across subtle mucosal transitions. This setting favors selective local repair in prediction space over reprocessing the entire mask. We therefore propose RIGS-Refiner, a lightweight post-refinement plugin for risk-guided recursive refinement in prediction space. Starting from a frozen host anchor prediction, RIGS-Refiner extracts lightweight image priors and prediction cues, applies risk-guided update, and writes back residual corrections through a shared recursive cell. The module adds only +519 parameters and +0.631 GFLOPs, keeping the refinement path compact for deployment. Experiments use Kvasir-SEG for training and Kvasir, ClinicDB, ColonDB, and ETIS for evaluation under two frozen hosts, namely PraNet and SegFormer-B0. Results show consistent gains on both hosts and a favorable efficiency-accuracy trade-off against representative post-refinement methods. Code is available at https://github.com/tyui99/RIGS-Refiner.