CASE: Concept-Aware Segmentation from Positive and Negative Visual Exemplars

Few-Shot Semantic Segmentation (FSS) focuses on segmenting novel object categories from only a handful of annotated examples. Most existing approaches rely on extensive episodic training to learn transferable representations, which is both computationally demanding and sensitive to distribution shifts. In this work, we revisit FSS from the perspective of modern vision foundation models and explore the potential of Segment Anything Model 3 (SAM3) as a training-free solution. By repurposing its Promptable Concept Segmentation (PCS) capability, we adopt a simple spatial concatenation strategy that places support and query images into a shared canvas, allowing a fully frozen SAM3 to perform segmentation without any fine-tuning or architectural changes. Experiments on PASCAL-$5^i$ and COCO-$20^i$ show that this minimal design already achieves state-of-the-art performance, outperforming many heavily engineered methods. Beyond empirical gains, we uncover that negative prompts can be counterproductive in few-shot settings, where they often weaken target representations and lead to prediction collapse despite their intended role in suppressing distractors. These findings suggest that strong cross-image reasoning can emerge from simple spatial formulations, while also highlighting limitations in how current foundation models handle conflicting prompt signals. Code at: https://github.com/WongKinYiu/FSS-SAM3

Promptable segmentation foundation models (FMs) such as SAM3 and Medical SAM3 promise few-shot, interactively-specified segmentation for medical imaging through a natural language interface, yet their performance on clinical tasks falls well short of this promise. We posit that this shortfall is not an artefact of insufficient medical pretraining or imperfect prompt phrasing, but a structural limitation that will persist in any domain where paired image-text supervision is scarce, as it is across most clinical modalities. We further hypothesize that the limitation is specific to natural language as a control signal: a visually grounded prompt, learned directly from the target distribution, should recover the lost performance without additional image-text data or backbone retraining. We propose Few-Shot Concept Prompt Learning (FS-CPL), which learns a continuous concept prompt embedding $\mathbf{p}^* \in \mathbb{R}^{T \times d}$ from a small support set of $K$ image--mask pairs via mask supervision, with the encoder-decoder backbone frozen. Across four public benchmarks spanning ultrasound and endoscopy (BUSI, HC18, TN3K, CVC-Clinic), FS-CPL delivers absolute Dice improvements of up to $+0.62$ over canonical text prompts and is backbone-agnostic: it lifts both vanilla SAM3 and the domain-specifically pretrained Medical SAM3, showing that visual concept prompting is complementary to in-domain pretraining.

Few-shot segmentation (FSS) aims to segment unseen object categories with a few (e.g., one or five) labeled examples, enabling efficient adaptation to novel classes. Conventional models typically rely on appearance-based visual matching between support and query images for segmentation. While straightforward, these methods often struggle to handle significant appearance discrepancies and occlusions in the query image due to insufficient target knowledge. To mitigate this, we introduce a novel framework that mines target knowledge using the strong reasoning capacity of Multimodal Large Language Models (MLLMs) and employs it to enhance FSS. Specifically, building on SAM 2, our method, named MK-FSS, exploits two forms of complementary knowledge derived from a query image by an MLLM for FSS, including spatial knowledge, which provides a spatial prior indicating the potential target location, and semantic knowledge, which describes the target using text. The spatial knowledge is first encoded into a memory representation, and then resulting memory is integrated with the support-guided memory feature from query image through a carefully designed dual-memory debate-fusion (DMDF) module, yielding a more robust target memory feature. In parallel, the semantic knowledge is encoded into the textual feature, which is fused with multi-scale query features via a progressive cross-modal prompt generator (PCPG), producing a target-aware multimodal prompt for segmentation. Working together, the dual-memory feature and the multimodal prompt provide a comprehensive representation of the target, enabling more robust segmentation. In our extensive experiments, MK-FSS shows promising results and largely surpasses existing methods. Code will be released.