BloodContourNet: A YOLO-Based Density-Aware Bézier Refinement Framework for Peripheral Blood Cell Detection.

Background/Objectives: Accurate peripheral blood cell detection remains difficult in dense smear fields, where touching erythrocytes, small platelets, and staining variability reduce the reliability of box-based object detectors. This study aims to address these limitations by proposing BloodContourNet, a contour-informed and density-aware detection framework for red blood cell, white blood cell, and platelet localization. Method: BloodContourNet is built on YOLOv26-L and integrates three complementary modules. The Hematological Attention Module (HAM) refines high-level features using local convolution and shifted-window attention. The Density-Aware Reweighting Head (DARH) modulates the classification loss for locally sparse or difficult instances without image-level resampling. The Bézier Contour Refinement Head (BCRH) provides a weakly supervised geometric overlap cue for ambiguous dense-region post-processing. Results: Experiments on the TXL-PBC dataset, containing 1260 peripheral smear images and 18,143 annotated cells, benchmarked 25 YOLO variants and 10 Transformer-based or reference detectors under a unified split and evaluation protocol. Across five random seeds, BloodContourNet achieved 99.1% mean Average Precision (mAP) at 50% Intersection-over-Union (IoU) and 87.8% mAP@50:95, improving strict-IoU performance by 1.4 points over YOLOv26-L and 0.7 points over DINO-DETR. Both margins were statistically significant across the five seeds (paired two-sided t-tests, both p < 0.05), and the five-seed 95% confidence interval of the proposed model was [87.5, 88.0]. Conclusions: BloodContourNet primarily improved the strict-localization setting on TXL-PBC, where dense erythrocyte regions and small platelet instances remain challenging for box-based detectors. External patient- or slide-independent validation remains necessary before broader clinical claims can be made.