Prompt-Conditioned Channel Attention for Hierarchical Feature Modulation toward Anatomy-Agnostic Segmentation

Anatomically plausible segmentation remains challenging because of low contrast, ambiguous boundaries, and modality-specific artifacts. Interactive segmentation has emerged as a promising strategy to guide feature extraction and improve localization, particularly in structurally ambiguous regions. However, existing methods integrate prompts through late-stage fusion and lack explicit mechanisms for prompt-driven channel-wise modulation across hierarchical feature representations, limiting their ability to capture deeper contextual and modality-specific variations. To address these limitations, we introduce Prompt-Conditioned Channel Attention (PCCA), a novel modulation mechanism that enables deep, hierarchical integration of semantic prompts within encoder-decoder networks. PCCA extracts compact channel descriptors via pooling, projects them into a shared space, and fuses them through a gated excitation mechanism to compute prompt-aware channel attention weights. These weights adaptively recalibrate feature responses across multiple network stages, enabling prompt-conditioned, semantically enriched hierarchical representations. Building on this, we propose PROMISE-Net, instantiated in two network variants: a convolutional model (PROMISE-CNN) and a transformer-based model (PROMISE-Txformer). Across the ISIC-Lesion, Kvasir-Polyp, CAMUS-Cardiac, and Kvasir-Instrument benchmarks, integrating PCCA into PROMISE-CNN yielded relative IoU gains of 10.4%, 8.7%, 0.8%, and 3.4%, respectively, over the baseline U-Net, while PROMISE-Txformer achieved corresponding gains of 7.6%, 23.0%, 2.1%, and 1.1%, respectively, over the baseline UNETR. These results show consistent improvements across architectures, imaging modalities, and anatomical targets, establishing PCCA and PROMISE-Net as a scalable, generalizable framework for prompt-aware hierarchical feature modulation in medical image segmentation.