# Adaptive Conformal Redistribution for Inter-class Transitional Uncertainty in Medical Image Classification

arXiv: https://arxiv.org/abs/2609.13303 · HTML: https://mlsanity.com/paper/2609.13303/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 26 of its 49 references that are in the map.
- First posted on arXiv 10 Sep 2026.

## Builds on (most cited first, 26 of 26)

- [An Image is Worth 16x16 Words: Transformers for Image Recognition at Scale](https://mlsanity.com/paper/2010.11929/) (2020)
- [Gemini 2.5: Pushing the Frontier with Advanced Reasoning, Multimodality, Long Context, and Next Generation Agentic Capabilities](https://mlsanity.com/paper/2507.06261/) (2025)
- [Class-Balanced Loss Based on Effective Number of Samples](https://mlsanity.com/paper/1901.05555/) (2019)
- [A Gentle Introduction to Conformal Prediction and Distribution-Free Uncertainty Quantification](https://mlsanity.com/paper/2107.07511/) (2021)
- [BiomedCLIP: a multimodal biomedical foundation model pretrained from fifteen million scientific image-text pairs](https://mlsanity.com/paper/2303.00915/) (2023)
- [MedGemma Technical Report](https://mlsanity.com/paper/2507.05201/) (2025)
- [Classification with Valid and Adaptive Coverage](https://mlsanity.com/paper/2006.02544/) (2020)
- [Uncertainty Sets for Image Classifiers using Conformal Prediction](https://mlsanity.com/paper/2009.14193/) (2020)
- [Least Ambiguous Set-Valued Classifiers with Bounded Error Levels](https://mlsanity.com/paper/1609.00451/) (2016)
- [Diffusion Models for Medical Image Analysis: A Comprehensive Survey](https://mlsanity.com/paper/2211.07804/) (2022)
- [GAN-based Synthetic Medical Image Augmentation for increased CNN Performance in Liver Lesion Classification](https://mlsanity.com/paper/1803.01229/) (2018)
- [Exploring Uncertainty Measures in Deep Networks for Multiple Sclerosis Lesion Detection and Segmentation](https://mlsanity.com/paper/1808.01200/) (2018)
- [A Patient-Centric Dataset of Images and Metadata for Identifying Melanomas Using Clinical Context](https://mlsanity.com/paper/2008.07360/) (2020)
- [Understanding Hallucinations in Diffusion Models through Mode Interpolation](https://mlsanity.com/paper/2406.09358/) (2024)
- [A Review of Uncertainty Estimation and its Application in Medical Imaging](https://mlsanity.com/paper/2302.08119/) (2023)
- [BIOMEDICA: An Open Biomedical Image-Caption Archive, Dataset, and Vision-Language Models Derived from Scientific Literature](https://mlsanity.com/paper/2501.07171/) (2025)
- [RET-CLIP: A Retinal Image Foundation Model Pre-trained with Clinical Diagnostic Reports](https://mlsanity.com/paper/2405.14137/) (2024)
- [Decomposing Disease Descriptions for Enhanced Pathology Detection: A Multi-Aspect Vision-Language Pre-training Framework](https://mlsanity.com/paper/2403.07636/) (2024)
- [Conformal Prediction for Class-wise Coverage via Augmented Label Rank Calibration](https://mlsanity.com/paper/2406.06818/) (2024)
- [Improving Medical Multi-modal Contrastive Learning with Expert Annotations](https://mlsanity.com/paper/2403.10153/) (2024)
- [Empirical Validation of Conformal Prediction for Trustworthy Skin Lesions Classification](https://mlsanity.com/paper/2312.07460/) (2023)
- [Aligning Medical Images with General Knowledge from Large Language Models](https://mlsanity.com/paper/2409.00341/) (2024)
- [Counting Hallucinations in Diffusion Models](https://mlsanity.com/paper/2510.13080/) (2025)
- [Health AI Developer Foundations](https://mlsanity.com/paper/2411.15128/) (2024)
- [Generating crossmodal gene expression from cancer histopathology improves multimodal AI predictions](https://mlsanity.com/paper/2502.00568/) (2025)
- [Conformal uncertainty quantification to evaluate predictive fairness of foundation AI model for skin lesion classes across patient demographics](https://mlsanity.com/paper/2503.23819/) (2025)

## Abstract (arXiv)

Medical image classification is frequently complicated by transitional categories whose feature distributions overlap those of adjacent classes, producing ambiguous decision boundaries. Conformal prediction returns uncertainty-aware prediction sets, but these are not directly actionable in clinical screening, where a single decision is required. This work proposes adaptive conformal redistribution (AdaConRed), a label-free post-conformal decision rule that converts ambiguous prediction sets into refined class assignments. A five-stage pipeline is developed. Vision-language generative augmentation addresses minority-class scarcity; a frozen DermFoundation encoder provides embeddings; a lightweight multi-layer perceptron performs classification; an entropy-modulated, margin-aware nonconformity score constructs adaptive prediction sets; samples predicted as transitional with multi-label sets are reassigned to the most probable alternative class within the set, using only model outputs at inference. Evaluation uses the OSCC oral lesion and ISIC skin lesion benchmarks at a miscoverage level of 0.2. On the 3-class OSCC benchmark, overall accuracy improves from 73.54% to 77.38%, with oral cancer accuracy rising from 64.29% to 82.14% and benign accuracy from 56.57% to 70.20%. Reassignment of transitional samples reduces OPMD accuracy from 84.78% to 80.16%, consistent with the asymmetric cost of missed malignancy. On ISIC, overall accuracy improves from 85.83% to 87.19%, melanoma accuracy rising from 66.04% to 68.34%. AdaConRed outperforms LAC, APS and RAPS under an identical backbone and redistribution rule. Conformal prediction can be extended beyond uncertainty quantification toward actionable decision support where transitional disease categories are present, with gains concentrated in the clinically critical malignant categories. Code repository: https://github.com/saibal436ghosh/AdaConRed.