MATS: A Multi-Agent Framework for Controllable and Reflective Tumor Synthesis

Synthesizing realistic tumors on medical images helps address data scarcity for clinical AI. Existing diffusion-based methods, however, lack fine-grained attribute-level controllability, closed-loop quality verification, and awareness of which morphological patterns are underrepresented in the target distribution. We present MATS, a multi-agent framework for text-controllable, cross-organ tumor synthesis. Given a target disease, MATS first profiles its morphological distribution over a fine-grained attribute space covering tumor geometry and appearance, and constructs a generation plan that amplifies underrepresented subtypes while keeping common ones dominant. It then localizes the target organ, proposes anatomically valid placement, and executes two-stage diffusion to produce the tumor mask and render texture, each conditioned on the corresponding attributes. A closed-loop reflective mechanism verifies attribute alignment at three checkpoints throughout synthesis and provides targeted feedback to guide re-generation when misalignment is detected. Trained exclusively on a single-source pancreatic neuroendocrine tumor dataset, MATS consistently improves downstream segmentation both in-domain and across LiTS, KiTS, and MSD-Pancreas benchmarks, whereas most prior generative augmentation methods fall below real-only training.