Exploiting Target Knowledge from MLLMs for Robust Few-Shot Segmentation

Few-shot medical image segmentation (FS-MIS) aims to segment novel regions of interest (ROIs) from a few annotated support examples. Despite rapid progress, existing FS-MIS solutions span diverse paradigms but are evaluated under inconsistent settings, leaving their relative effectiveness unclear. We introduce FAME, a unified benchmark for evaluating FS-MIS solutions, covering specialists, SAM-based methods, CLIP-based methods, and MLLM-based methods. FAME contains 14,958 test samples across 7 anatomical sites, 9 imaging modalities, and 14 ROI categories, and evaluates models under zero-shot and ten-shot settings with additional assessment of target-absence recognition and generalization under covariate and semantic shifts. Our evaluation reveals several findings. First, effective few-shot segmentation depends on how models exploit support examples: direct visual adaptation generally outperforms prompt-based strategies. Second, increasing support examples improves performance only when models can effectively utilize them. Third, semantic transfer remains substantially more challenging than imaging-domain adaptation, and strong localization ability does not necessarily imply reliable target-absence recognition. We hope FAME provides a comprehensive understanding of current FS-MIS solutions and facilitates the development of more effective and reliable few-shot medical segmentation methods.

Few-shot segmentation asks a model to delineate a target class in a query image from only a handful of annotated examples, a setting most acute in remote sensing, where labels are scarce and the imagery departs sharply from the natural images on which vision backbones are pretrained. Prevailing approaches either train a segmenter on labelled episodes, which raises accuracy within the training distribution but binds the model to it, or reduce each class to a lossy summary of frozen features, a single prototype, a few cluster prototypes, or a discrete clustering, none of which preserves the internal structure of a multimodal class. We argue that a class is better described by a distribution than by a point, and that frozen self-supervised features already carry enough structure to estimate that distribution directly. We introduce FROST, a training-free few-shot segmenter that treats the reference foreground and background as two point clouds on the unit sphere of frozen DINOv3 features and labels each query token by a nonparametric density ratio, with a threshold the Bayes rule fixes at zero under equal priors. Because the variance of a density estimate shrinks as its sample grows, the decision sharpens as references accumulate, and every remaining quantity from the kernel bandwidth to the spatial gate is read from the support set rather than tuned. We develop FROST for overhead imagery, where a class is typically a scatter of many small and dissimilar instances that a density tracks but a lossy summary blurs. Across seventeen remote-sensing benchmarks FROST surpasses both training-free and learning-based methods, leading by 5.6 mIoU from a single annotated example and widening its lead as the support set grows, all while remaining among the smallest models compared. Code is available at https://github.com/jhpark-ai/FROST.

Cross-domain Few-shot Segmentation (CD-FSS) aims to transfer knowledge learned from source domain to distinct target domains, segmenting unseen target classes with only a few annotated samples. Although existing methods have made significant progress, they still rely on training or fine-tuning processes, which incur high computational costs and risk overfitting. We observe that when powerful and general-purpose vision foundation models are incorporated into these methods, their performance shows only marginal improvement or even degrades due to overfitting. To address this, we eliminate trainable parameters and propose a training-free framework to avoid both training overhead and overfitting. Built upon the self-supervised vision encoder DINOv3, our framework addresses cross-domain challenges through three core modules. First, the Semantic-aware Feature Re-fusion (SAFR) module identifies and re-fuses features that emphasize semantic patterns, generating representations with enhanced semantic discriminability. Additionally, the Adaptive Support Enhancement (ASE) module narrows semantic gaps between support and query through robust query information aggregation. Finally, the Hybrid Prototype Matching (HPM) module integrates matching results from diverse prototypes to adapt to varying semantic complexity across domains. Extensive experiments on four target domain datasets demonstrate that our method achieves state-of-the-art performance in CD-FSS without any training.