Conditional Diffusion Models are Medical Image Classifiers that Provide Explainability and Uncertainty for Free

Gian Mario Favero, Parham Saremi, Emily Kaczmarek, Brennan Nichyporuk, Tal Arbel

Keywords: diffusion, classification, explainability, uncertainty

Abstract: Discriminative classifiers have become a foundational tool in deep learning for medical imaging, excelling at learning separable features of complex data distributions. However, these models often need careful design, augmentation, and training techniques to ensure safe and reliable deployment. Recently, diffusion models have become synonymous with generative modeling in 2D. These models showcase robustness across a range of tasks including natural image classification, where classification is performed by comparing reconstruction errors across images generated for each possible conditioning input. This work presents the first exploration of the potential of class conditional diffusion models for 2D medical image classification. First, we develop a novel majority voting scheme shown to improve the performance of medical diffusion classifiers. Next, extensive experiments on the CheXpert and ISIC Melanoma skin cancer datasets demonstrate that foundation and trained-from-scratch diffusion models achieve competitive performance against SOTA discriminative classifiers without the need for explicit supervision. In addition, we show that diffusion classifiers are intrinsically explainable, and can be used to quantify the uncertainty of their predictions, increasing their trustworthiness and reliability in safety-critical, clinical contexts. Further information is available on our project page: https://faverogian.github.io/med-diffusion-classifier.github.io/.

Primary Subject Area: Generative Models

Secondary Subject Area: Interpretability and Explainable AI

Paper Type: Validation or Application

Registration Requirement: Yes

Reproducibility: https://github.com/faverogian/med-diffusion-classifier

Visa & Travel: Yes

Midl Latex Submission Checklist: Ensure no LaTeX errors during compilation., Created a single midl25_NNN.zip file with midl25_NNN.tex, midl25_NNN.bib, all necessary figures and files., Includes \documentclass{midl}, \jmlryear{2025}, \jmlrworkshop, \jmlrvolume, \editors, and correct \bibliography command., Did not override options of the hyperref package, Did not use the times package., All authors and co-authors are correctly listed with proper spelling and avoid Unicode characters., Author and institution details are de-anonymized where needed. All author names, affiliations, and paper title are correctly spelled and capitalized in the biography section., References must use the .bib file. Did not override the bibliographystyle defined in midl.cls. Did not use \begin{thebibliography} directly to insert references., Tables and figures do not overflow margins; avoid using \scalebox; used \resizebox when needed., Included all necessary figures and removed *unused* files in the zip archive., Removed special formatting, visual annotations, and highlights used during rebuttal., All special characters in the paper and .bib file use LaTeX commands (e.g., \'e for é)., Appendices and supplementary material are included in the same PDF after references., Main paper does not exceed 9 pages; acknowledgements, references, and appendix start on page 10 or later.

Submission Number: 214