Prompt-Anchored Residual Adaptation for Biomedical Vision-Language Models

Biomedical Vision--Language Models (VLMs) have shown remarkable promise in few-shot medical diagnosis but face a critical bottleneck: \textit{fragility to prompt variations}.Existing adaptation frameworks typically optimize visual and textual prompts as independent streams, relying on ideal ``Golden Prompts''. In clinical reality, where descriptions are often noisy and heterogeneous, this modality isolation leads to unstable cross-modal alignment. To address this, we propose BiomedAP, a vision-informed dual-anchor framework with gated cross-modal fusion.BiomedAP enforces synergistic alignment through two mechanisms: (1) Gated Cross-Modal Fusion, which enables layer-wise interaction between modalities, acting as a dynamic noise regulator to suppress irrelevant textual cues; and (2) a Dual-Anchor Constraint that regularizes learnable prompts toward stable semantic centroids derived from both expert templates (High Anchors) and few-shot visual prototypes (Low Anchors). Extensive experiments across 11 benchmarks demonstrate that BiomedAP consistently surpasses baselines, achieving competitive few-shot accuracy and markedly enhanced robustness under prompt perturbations. Our code is available at: https://github.com/tongdiedie/BiomedAP. Keywords: Vision-Language Models; Prompt Learning; Parameter-Efficient Fine-Tuning; Few-shot Learning

Accurate biomedical image classification under low-resource conditions remains challenging due to limited annotations, subtle inter-class visual differences, and complex disease semantics. While vision--language models offer a promising foundation for mitigating data scarcity, their effective adaptation in biomedical settings is constrained by the need for parameter-efficient tuning alongside fine-grained and semantically consistent representation learning. In this work, we propose Multi-View Synergistic Learning (MVSL), a unified framework that addresses these challenges by jointly considering adaptation paradigms, representation granularity, and disease semantic relationships. MVSL decouples the adaptation of visual and textual encoders to respect their distinct representational characteristics, enabling more stable and effective parameter-efficient fine-tuning. It further introduces multi-granularity contrastive learning to explicitly model both global image semantics and localized lesion-level evidence, improving fine-grained discrimination for visually similar disease categories. In addition, MVSL preserves disease-level semantic structure by incorporating structured supervision derived from large language models, which constrains textual representations at the class level and indirectly regularizes visual embeddings through cross-modal alignment. Together, these components enable more stable cross-modal alignment and improved discrimination under limited supervision. Extensive experiments on $11$ public biomedical datasets spanning $9$ imaging modalities and $10$ anatomical regions demonstrate that MVSL consistently outperforms state-of-the-art methods in few-shot and zero-shot classification settings.

Medical Vision-Language Models (VLMs) exhibit strong zero-shot performance, yet their effectiveness still declines on out-of-distribution (OOD) data due to domain shifts and class bias inherited from large-scale pretraining. Existing few-shot adaptation methods typically introduce additional trainable components, which can be unstable in extremely low-data regimes (e.g., 1-shot), and lack robustness on different medical data. We present TCLA, a purely training-free few-shot adaptation method for Medical VLMs, which is fast and model-agnostic. TCLA corrects inference logits based on a small set of support samples, boosting pretrained VLMs performance by improving inter-class deconfusion and reducing domain shift. Extensive experiments on nine datasets across multiple medical imaging modalities including X-ray, Ultrasound, MRI, CT, Histopathology, demonstrate that TCLA consistently improves OOD performance of Medical VLMs and, in most of cases, outperforms existing training-based adaptation methods.