# SAM-DCE: Addressing Token Uniformity and Semantic Over-Smoothing in Medical Segmentation

arXiv: https://arxiv.org/abs/2509.16886 · HTML: https://mlsanity.com/paper/2509.16886/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 19 of its 25 references that are in the map.
- First posted on arXiv 21 Sep 2025.

## Builds on (most cited first, 19 of 19)

- [U-Net: Convolutional Networks for Biomedical Image Segmentation](https://mlsanity.com/paper/1505.04597/) (2015)
- [Segment Anything](https://mlsanity.com/paper/2304.02643/) (2023)
- [TransUNet: Transformers Make Strong Encoders for Medical Image Segmentation](https://mlsanity.com/paper/2102.04306/) (2021)
- [Swin-Unet: Unet-like Pure Transformer for Medical Image Segmentation](https://mlsanity.com/paper/2105.05537/) (2021)
- [UNETR: Transformers for 3D Medical Image Segmentation](https://mlsanity.com/paper/2103.10504/) (2021)
- [Segment Anything Model for Medical Image Analysis: an Experimental Study](https://mlsanity.com/paper/2304.10517/) (2023)
- [Customized Segment Anything Model for Medical Image Segmentation](https://mlsanity.com/paper/2304.13785/) (2023)
- [Anti-Oversmoothing in Deep Vision Transformers via the Fourier Domain Analysis: From Theory to Practice](https://mlsanity.com/paper/2203.05962/) (2022)
- [SAM-Med3D: Towards General-purpose Segmentation Models for Volumetric Medical Images](https://mlsanity.com/paper/2310.15161/) (2023)
- [3D UX-Net: A Large Kernel Volumetric ConvNet Modernizing Hierarchical Transformer for Medical Image Segmentation](https://mlsanity.com/paper/2209.15076/) (2022)
- [SAM on Medical Images: A Comprehensive Study on Three Prompt Modes](https://mlsanity.com/paper/2305.00035/) (2023)
- [SAM Struggles in Concealed Scenes -- Empirical Study on Segment Anything](https://mlsanity.com/paper/2304.06022/) (2023)
- [Polyp-SAM: Transfer SAM for Polyp Segmentation](https://mlsanity.com/paper/2305.00293/) (2023)
- [How to Efficiently Adapt Large Segmentation Model(SAM) to Medical Images](https://mlsanity.com/paper/2306.13731/) (2023)
- [Unleashing the Potential of SAM for Medical Adaptation via Hierarchical Decoding](https://mlsanity.com/paper/2403.18271/) (2024)
- [TransDeepLab: Convolution-Free Transformer-based DeepLab v3+ for Medical Image Segmentation](https://mlsanity.com/paper/2208.00713/) (2022)
- [SkinSAM: Empowering Skin Cancer Segmentation with Segment Anything Model](https://mlsanity.com/paper/2304.13973/) (2023)
- [SEG-SAM: Semantic-Guided SAM for Unified Medical Image Segmentation](https://mlsanity.com/paper/2412.12660/) (2024)
- [PG-SAM: Prior-Guided SAM with Medical for Multi-organ Segmentation](https://mlsanity.com/paper/2503.18227/) (2025)

## Abstract (arXiv)

The Segment Anything Model (SAM) demonstrates impressive zero-shot segmentation ability on natural images but encounters difficulties in medical imaging due to domain shifts, anatomical variability, and its reliance on user-provided prompts. Recent prompt-free adaptations alleviate the need for expert intervention, yet still suffer from limited robustness and adaptability, often overlooking the issues of semantic over-smoothing and token uniformity. We propose SAM-DCE, which balances local discrimination and global semantics while mitigating token uniformity, enhancing inter-class separability, and enriching mask decoding with fine-grained, consistent representations. Extensive experiments on diverse medical benchmarks validate its effectiveness.