# InstEditSeg: Instruction-Driven Image Editing for Polyp and Skin Lesion Segmentation

arXiv: https://arxiv.org/abs/2609.02004 · HTML: https://mlsanity.com/paper/2609.02004/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 38 of its 45 references that are in the map.
- First posted on arXiv 2 Sep 2026.

## Builds on (most cited first, 30 of 38)

- [Denoising Diffusion Probabilistic Models](https://mlsanity.com/paper/2006.11239/) (2020)
- [U-Net: Convolutional Networks for Biomedical Image Segmentation](https://mlsanity.com/paper/1505.04597/) (2015)
- [High-Resolution Image Synthesis with Latent Diffusion Models](https://mlsanity.com/paper/2112.10752/) (2021)
- [Denoising Diffusion Implicit Models](https://mlsanity.com/paper/2010.02502/) (2020)
- [Segment Anything](https://mlsanity.com/paper/2304.02643/) (2023)
- [Adding Conditional Control to Text-to-Image Diffusion Models](https://mlsanity.com/paper/2302.05543/) (2023)
- [SAM 2: Segment Anything in Images and Videos](https://mlsanity.com/paper/2408.00714/) (2024)
- [InstructPix2Pix: Learning to Follow Image Editing Instructions](https://mlsanity.com/paper/2211.09800/) (2022)
- [UNet++: A Nested U-Net Architecture for Medical Image Segmentation](https://mlsanity.com/paper/1807.10165/) (2018)
- [Attention U-Net: Learning Where to Look for the Pancreas](https://mlsanity.com/paper/1804.03999/) (2018)
- [T2I-Adapter: Learning Adapters to Dig out More Controllable Ability for Text-to-Image Diffusion Models](https://mlsanity.com/paper/2302.08453/) (2023)
- [Kvasir-SEG: A Segmented Polyp Dataset](https://mlsanity.com/paper/1911.07069/) (2019)
- [Skin Lesion Analysis Toward Melanoma Detection: A Challenge at the 2017 International Symposium on Biomedical Imaging (ISBI), Hosted by the International Skin Imaging Collaboration (ISIC)](https://mlsanity.com/paper/1710.05006/) (2017)
- [Medical SAM Adapter: Adapting Segment Anything Model for Medical Image Segmentation](https://mlsanity.com/paper/2304.12620/) (2023)
- [Pix2seq: A Language Modeling Framework for Object Detection](https://mlsanity.com/paper/2109.10852/) (2021)
- [SegDiff: Image Segmentation with Diffusion Probabilistic Models](https://mlsanity.com/paper/2112.00390/) (2021)
- [Diffusion Models for Medical Image Analysis: A Comprehensive Survey](https://mlsanity.com/paper/2211.07804/) (2022)
- [Unleashing Text-to-Image Diffusion Models for Visual Perception](https://mlsanity.com/paper/2303.02153/) (2023)
- [CLIP-Driven Universal Model for Organ Segmentation and Tumor Detection](https://mlsanity.com/paper/2301.00785/) (2023)
- [ResUNet++: An Advanced Architecture for Medical Image Segmentation](https://mlsanity.com/paper/1911.07067/) (2019)
- [Skin Lesion Analysis toward Melanoma Detection: A Challenge at the International Symposium on Biomedical Imaging (ISBI) 2016, hosted by the International Skin Imaging Collaboration (ISIC)](https://mlsanity.com/paper/1605.01397/) (2016)
- [Diffusion Models for Implicit Image Segmentation Ensembles](https://mlsanity.com/paper/2112.03145/) (2021)
- [MedSegDiff: Medical Image Segmentation with Diffusion Probabilistic Model](https://mlsanity.com/paper/2211.00611/) (2022)
- [Polyp-PVT: Polyp Segmentation with Pyramid Vision Transformers](https://mlsanity.com/paper/2108.06932/) (2021)
- [MedSegDiff-V2: Diffusion based Medical Image Segmentation with Transformer](https://mlsanity.com/paper/2301.11798/) (2023)
- [A Generalist Framework for Panoptic Segmentation of Images and Videos](https://mlsanity.com/paper/2210.06366/) (2022)
- [MedSAM2: Segment Anything in 3D Medical Images and Videos](https://mlsanity.com/paper/2504.03600/) (2025)
- [Polyp-SAM: Transfer SAM for Polyp Segmentation](https://mlsanity.com/paper/2305.00293/) (2023)
- [EMCAD: Efficient Multi-scale Convolutional Attention Decoding for Medical Image Segmentation](https://mlsanity.com/paper/2405.06880/) (2024)
- [A multi-centre polyp detection and segmentation dataset for generalisability assessment](https://mlsanity.com/paper/2106.04463/) (2021)

## Abstract (arXiv)

Accurate segmentation of polyps and skin lesions is pivotal for clinical diagnosis, yet existing methods struggle with low contrast, ambiguous boundaries, and cross-domain distribution discrepancies. Discriminative networks and most diffusion-based segmentation approaches predict standalone binary masks, leaving the visual priors of large-scale pretrained generative models largely unexploited. We propose InstEditSeg, a unified generative framework that reformulates medical segmentation as an instruction-driven image editing problem. Instead of emitting a mask, the model renders a color-coded overlay on the original image, conditioned on a textual instruction, so that the edited output aligns with the natural image distribution learned by latent diffusion models and mitigates the domain gap between natural and medical imagery. To recover fine anatomical structures, we introduce DINOv3 as an auxiliary visual encoder and a DINO Feature Guidance Block that builds a multi-scale feature pyramid. The pyramid is fused into the diffusion U-Net by channel concatenation and zero-initialized convolution so that hierarchical discriminative priors can be injected without perturbing the pretrained weights. A dual-branch classifier-free guidance strategy requiring only two forward passes per denoising step reduces inference cost. On polyp and skin lesion benchmarks the framework achieves accuracy competitive with strong discriminative baselines, and it further demonstrates concrete advantages of the generative formulation: notably better cross-domain generalization on unseen data, more complete multi-lesion segmentation, instruction-conditioned task control, and sampling flexibility. We also analyze the strengths and limitations of the paradigm, including its color sensitivity and unsupported attribute-conditioned selection. Code is available at: https://github.com/wincharm001/InstEditSeg.