无需异常标签，逐步学习正常样本以提升医学影像异常检测精度。

Unknown anomaly detection in medical imaging remains a fundamental challenge due to the scarcity of labeled anomalies and the high cost of expert supervision. We introduce an unsupervised, oracle-free framework that incrementally expands a trusted set of normal samples without any anomaly labels. Starting from a small, verified seed of normal images, our method alternates between lightweight adapter updates and uncertainty-gated sample admission. A frozen pretrained vision backbone is augmented with tiny convolutional adapters, ensuring rapid domain adaptation with negligible computational overhead. Extracted embeddings are stored in a compact coreset enabling efficient k-nearest neighbor anomaly (k-NN) scoring. Safety during incremental expansion is enforced by dual probabilistic gates, a sample is admitted into the normal memory only if its distance to the existing coreset lies within a calibrated z-score threshold, and its SWAG-based epistemic uncertainty remains below a seed-calibrated bound. This mechanism prevents drift and false inclusions without relying on generative reconstruction or replay buffers. Empirically, our system steadily refines the notion of normality as unlabeled data arrive, producing substantial gains over baselines. On COVID-CXR, ROC-AUC improves from 0.9489 to 0.9982 (F1: 0.8048 to 0.9746); on Pneumonia CXR, ROC-AUC rises from 0.6834 to 0.8968; and on Brain MRI ND-5, ROC-AUC increases from 0.6041 to 0.7269 and PR-AUC from 0.7539 to 0.8211. These results highlight the effectiveness and efficiency of the proposed framework for real-world, label-scarce medical imaging applications.