Title:TIER-MoE: Trust-Informed Expert Routing via Conditional Modality Risk for Multimodal Fusion in Biomedical Classification

Abstract:The promise of multimodal fusion lies in combining complementary sources of evidence, yet more evidence does not always yield a better prediction. Recent multimodal models have advanced fusion through richer cross-modal interaction and sample-adaptive fusion. However, the influence assigned to a modality during fusion does not reveal whether that source is unreliable, redundant, or poorly matched to a specialized expert. To address this limitation, we introduce TIER-MoE, a risk-guided subspace mixture-of-experts model that defines sample-specific modality reliability as the prediction loss its unimodal predictor is expected to incur. This risk is learned from out-of-fold predictions generated by models that were not trained on the corresponding sample. TIER-MoE combines the estimated risk with expert-specific subspace compatibility for sparse modality-expert routing, while an always-active shared path preserves multimodal complementarity. We evaluate TIER-MoE on four public multimodal biomedical datasets spanning Alzheimer's disease status, skin-lesion malignancy, and retinal classification. Results demonstrate its superiority over state-of-the-art methods in predictive performance and probability calibration, with consistent improvements in Macro-F1 and Brier score and strong zero-shot generalization to an external cohort.

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