Abstract: Semi-supervised learning has shown great potential for reducing annotation costs in medical image segmentation. However, most existing methods mainly exploit unlabeled data through prediction-level consistency, while the reliability of internal feature representations is often overlooked. In medical images, target-related structural cues are easily entangled with unstable appearance variations, which may lead to unreliable pseudo labels and error accumulation during training. To address these issues, we propose SAUF-Net, a Structure–Appearance Representation Learning with Uncertainty Feedback Network for semi-supervised medical image segmentation. SAUF-Net uses the Structure–Appearance Decomposition Module (SADM) to separate bottleneck features into structural and appearance representations. The Disentangled Guidance Module (DGM) injects these representations into the decoding process to enhance structure-aware segmentation. Meanwhile, the Auxiliary Decoder produces branch-specific predictions for reliability estimation and a fused prediction for appearance-swapped consistency. Furthermore, we introduce an Appearance-Swapped Consistency branch to encourage structural representations to remain stable under appearance variations. We also introduce a reliability-map-guided dual-head discriminator with a Validity Head and an Uncertainty Head to provide feature-level uncertainty feedback. Extensive experiments on ISIC-2016 and Kvasir-SEG demonstrate that SAUF-Net outperforms state-of-the-art semi-supervised methods, especially under low-label settings.
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