A Unified Dual-Stream Framework for Heterogeneous and Imbalanced Medical Image Classification

Abstract

Medical image classification models often struggle to generalise across heterogeneous clinical domains owing to variations in visual characteristics, acquisition conditions, and class imbalance. Existing studies largely address these challenges independently, with limited investigation into their combined impact on classification robustness. This paper proposes a lightweight dual-stream framework based on a pretrained ConvNeXt-Tiny backbone, integrating complementary global semantic and local structural feature representations with imbalance-aware optimisation. Rather than modifying the backbone, the framework enhances feature discrimination through dual-stream processing while incorporating class-balanced focal loss and stratified sampling for minority-class recognition. The framework is evaluated independently on four public datasets spanning dermatology, ophthalmology, and gastrointestinal endoscopy using five-fold cross-validation to assess architectural robustness across heterogeneous domains rather than cross-domain transfer of a single trained model. Experimental results show strong performance across all datasets, achieving AUC values above 0.92. Ablation studies confirm that dual-stream representation learning provides the primary performance gains, while imbalance-aware optimisation further improves robustness under severe class imbalance. These findings demonstrate an effective and practical solution for medical image classification across heterogeneous clinical imaging domains without requiring dataset-specific architectural modifications. Limitations regarding independent per-domain (rather than cross-domain) evaluation, baseline comparability, and incomplete quantitative calibration analysis are discussed explicitly and identified as directions for future work.