CoDiR: Confidence-Guided Diffusion Refinement for Semi-Supervised Histopathology Segmentation

Supervised deep learning achieves strong performance in biomedical image segmentation but relies on costly pixel-wise annotations, motivating semi-supervised approaches that exploit unlabeled data. We introduce a diffusion-based teacher--student framework in which segmentation predictions are used to condition image denoising, encouraging the production of more informative pseudo-labels. The teacher is first pretrained through an unsupervised reconstruction task using diffusion-style corruption, timestep conditioning, and denoising. Starting from a corrupted empty mask, the model predicts an intermediate segmentation that conditions image denoising, encouraging the predicted mask to capture structural information useful for recovering the original image. The resulting teacher is then co-trained with a student using supervised segmentation on labeled samples and cross pseudo-supervision on unlabeled data. We further introduce a multi-round extension during co-training, in which the teacher generates multiple stochastic image reconstructions and corresponding segmentation predictions, providing additional reconstruction and alignment signals to improve its pseudo-labels. We evaluate the proposed framework on three public 2D biomedical segmentation datasets and a 3D left atrial segmentation benchmark. Across several labeling regimes, our method achieves competitive or superior performance compared with state-of-the-art semi-supervised approaches, with the largest gains observed under severe label scarcity.

Semi-supervised learning addresses label scarcity and high annotation costs in medical image segmentation by exploiting the latent information in unlabeled data to enhance model performance. Traditional discriminative segmentation relies on segmentation masks, neglecting feature-level distribution constraints. This limits robust semantic representation learning and adaptive modeling of unlabeled data in scenarios with few labels. To address these limitations, we propose SemiGDA, a novel Generative Dual-distribution Alignment framework for semi-supervised medical image segmentation. Our SemiGDA overcomes the reliance of discriminative methods on large labeled datasets by aligning feature and semantic distributions to boost semantic learning and scene adaptability. Specifically, we propose a Dual-distribution Alignment Module (DAM), which employs two structurally distinct encoders to model image and mask feature distributions. It enforces their alignment in the latent space via distributional constraints, establishing structured feature consistency. Moreover, we design a Consistency-Driven Skip Adapter (CDSA) strategy, which introduces dual skip adapters (Image and Mask) to fuse multi-scale features via skip connections. Using a consistency loss, CDSA enhances cross-branch semantic alignment and reinforces fine-grained semantic consistency. Experimental results on diverse medical datasets show that our method outperforms other state-of-the-art semi-supervised segmentation methods. Code is released at: https://github.com/taozh2017/SemiGDA.

Weakly supervised semantic segmentation enables histopathology tissue segmentation from image-level annotations, avoiding costly pixel-level labeling by expert pathologists. However, CAM-based methods often localize only highly discriminative regions and remain unreliable near tissue interfaces. We propose ProBAG, a stage-1 pseudo-mask generator that combines dataset-specific visual prototypes with pathology-aligned CONCH text prototypes over multi-scale frozen UNI features. ProBAG introduces two complementary mechanisms: class-wise power recalibration that reshapes inter-class competition while preserving the total foreground activation mass at each pixel, and one-step graph diffusion in which feature affinities are penalized by a late-transformer attention-context discrepancy used as a soft structural boundary cue. The resulting stage-1 pseudo-masks require neither CRF nor an external segmentation model; for complete two-stage comparison, they additionally supervise a downstream Phikon-FPN segmenter. Experiments on BCSS-WSSS and LUAD-HistoSeg show consistent gains over recent WSSS approaches, while ablations indicate that pathology-aligned text semantics provide the largest improvement and graph refinement provides a smaller complementary gain. The code is available at: https://github.com/wterrr/WSSS