Neighboring-slice self-supervised denoising is attractive for volumetric medical imaging, yet inter-slice misalignment breaks anatomical correspondence and often yields ghosting and blurred margins when adjacent slices are used naively as targets. We propose Neighbor-Guided Patch Sampling (NGPS), a lightweight framework that constructs neighboring supervision under local inter-slice misalignment without explicit registration. To avoid learning from misleading targets, prior methods commonly mask discrepant regions, but this stabilizes training at the cost of leaving a non-trivial portion of neighboring evidence unexploited, particularly around high-frequency anatomical boundaries. NGPS addresses this by decoupling structure matching from signal retrieval: for each masked location, it searches a local neighborhood for structurally similar candidate patches using a simple guide image (e.g., fast bilateral filtering), while retrieving the supervision signal directly from the raw noisy neighbor at the matched coordinates. By matching on a noise-attenuated guide while retrieving raw values from neighboring slices, NGPS constructs local pseudo targets without a learned registration module. Across the evaluated CT and synthetic-Rician MRI settings, NGPS improves fidelity and structure-sensitive metrics. Code is available at https://github.com/cv-cho/NGPS .

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