Solving the Needle-in-a-Haystack Problem in Mammography Vision-Language Model with Differentiable Subset Sampling

There is growing interest in adopting CLIP-style vision--language model (VLM) pretraining for mammography. However, models that directly employ the standard CLIP architecture and training objective exhibit limited zero-shot performance in clinically important tasks such as cancer, finding-type, and BI-RADS predictions. We argue that this underwhelming performance is due to neglecting two characteristics of mammography data: (1) its high-res nature, and (2) homogeneity of radiology reports, largely driven by a predominance of negative/benign findings on examinations. We propose TopKSigLIP, a VLM designed to address these two limitations through a novel architecture and learning objectives. Instead of downscaling high-res mammography images to satisfy GPU memory constraints, TopKSigLIP introduces TopK-Patch module that learns to sample a sparse set of high-res patches likely to contain lesions, sidestepping the resolution--batch size tradeoff of VLM training. The sampled patch locations additionally serve as a built-in localization tool. To address report homogeneity, we replace the contrastive loss, which falsely repels semantically similar pairs, with a Sup-sigmoid loss. Sup-sigmoid loss extends the sigmoid loss from SigLIP with soft labels derived from structured data. TopKSigLIP outperforms existing open-source mammography and general medical VLMs on both internal and external benchmarks on density assessment, BI-RADS classification, finding subtyping, and cancer prediction under zero-shot evaluation. TopKSigLIP remains competitive under linear probing despite using a significantly smaller vision encoder and smaller training batches than baselines. The TopK-Patch module additionally achieves superior lesion localization over post-hoc Grad-CAM. Code and weights are made public:https://github.com/Youngseok0001/TopKSigLIP.

TRUST: Threshold-Recalibrated Uncertainty-Safe Training for Certified Dismissal in Breast Cancer Screening

Reducing the review of clearly cancer-negative screening mammograms could lower radiologist workload without compromising cancer detection. We propose a closed-loop threshold-aware training strategy in which the dismissal threshold is recalculated during training and used to penalize cancer-positive images that approach the dismissal region. We evaluated the method on NLBS and RSNA using five controlled training configurations, with case-level assessment based on a one-sided 99\% Clopper--Pearson upper bound for cancer prevalence among dismissed cases. The proposed model achieved the highest case-level dismissal rates at both 98\% and 95\% recall targets. On NLBS, dismissal reached 19.74\% and 21.70\%, while the cross-entropy baseline did not meet either recall target. On RSNA, dismissal improved from 7.04\% to 14.31\% and from 13.49\% to 19.69\%. In external RSNA$\to$NLBS evaluation, the proposed model achieved dismissal rates of 12.95\% and 19.87\% at the 98\% and 95\% recall targets, respectively. These results support closed-loop threshold-aware training for high-recall selective dismissal.

DualMiT-Net: Local-Global Transformer-Convolutional Fusion for Breast Mass Segmentation in Mammographic Regions of Interest

Breast mass segmentation is an important step in computer-aided mammography, but it remains difficult because masses can have low contrast, irregular shapes, and boundaries that blend with surrounding breast tissue. To address this problem, we present DualMiT-Net, a dual-branch network that uses both a focused view of the mass and a wider view of the surrounding tissue. The local branch uses a Mix Transformer (MiT-B5) encoder to learn mass shape, texture, and boundary information, while the global branch uses an EfficientNet-B5 encoder to learn surrounding breast context. Features from the two branches are shared at the deeper encoder levels and are then progressively fused in a single decoder. A spatial gate controls how much global information is added during decoding. We also evaluated four input representations and selected a percentile-windowed mammogram combined with a Gabor texture response. The model was trained and evaluated on the mass subset of the Curated Breast Imaging Subset of the Digital Database for Screening Mammography (CBIS-DDSM) using a patient-level split. Across three training runs, DualMiT-Net with exponential moving average weights achieved a mean Dice coefficient of 0.9375 and a mean Intersection over Union of 0.8834. It also achieved better Dice and IoU scores than six standard encoder-decoder baselines trained using the same data and training settings. These results show that combining local mass information with wider breast context can provide accurate and consistent breast mass segmentation.

MammoMix: Leveraging Mixture of Experts for Robust Mammogram Breast Detection

Breast lesion detection in mammography remains a challenging task due to variations in image quality, lesion appearance, and population demographics across datasets. While current object detectors such as YOLO and DETR achieve strong results on individual datasets, their performance often degrades when trained on or applied across heterogeneous sources. To address this, we propose MammoMix, a novel framework based on Mixture-of-Experts (MoE) paradigm for robust and generalizable lesion detection. In MammoMix, each expert model is trained on a specific domain, allowing it to specialize in distinct characteristics of its source data. A gating mechanism adaptively weighs contributions from each expert based on input image, combining their outputs to enable domain-adaptive inference. To improve reliability, we further incorporate a calibration module, MoCAE, which adjusts confidence scores to reflect true predictive uncertainty. We evaluate MammoMix on 3 public mammography datasets: CSAW, DDSM, and DMID, covering diverse clinical settings. Results show that MammoMix outperforms baseline detectors in both average precision and reliability, particularly on datasets with greater variability. Our findings demonstrate that expert specialization and calibrated ensemble fusion significantly enhance model generalization and robustness. MammoMix offers a promising step toward dependable AI-assisted breast cancer screening across real-world clinical domains.

BreastMammo and DenseMammo: Benchmarks for Mammography Domain Generalization

Breast density classification is a critical component of breast cancer risk assessment, yet AI models often struggle to generalize across clinical sites due to vendor-specific acquisition styles. In this work, we introduce two new datasets, BreastMammo and DenseMammo, to facilitate robust multi-view mammography research. We propose a domain generalization framework that utilizes a foreground-only histogram matching protocol to resolve the domain shift issue arising from disparate clinical sources. Internal evaluation using a 5-fold cross-validation protocol demonstrates the efficacy of our approach, with the Swin Transformer backbone achieving a peak AUC of 98.32% for density classification. External evaluation on the TNMammo and LUMINA datasets demonstrates that the proposed approach consistently reduces domain shift, significantly outperforming prominent domain generalization paradigms, including MixStyle and Discrete-Fourier-Transform-based frameworks.

Modern Backbones Improve Multi-task DETR for Mammography Classification and Lesion Localization

Joint exam-level prediction and candidate-region localization may improve the usefulness of AI support in mammography. We study this setting using a multi-task DETR framework, where shared representations support both image-level malignancy prediction and lesion localization, and evaluate its performance on OPTIMAM and a biopsy-confirmed SGM1k cohort. Across both datasets, modern backbones consistently outperformed older ResNet-style features, with ConvNeXtV2 and DINOv3 giving the strongest overall results, whereas MambaVision was less competitive. On OPTIMAM, ConvNeXtV2 achieved the best overall performance, reaching 97.96% AUC, 99.89% sensitivity, 25.08% mAP@.5, and 74.38% recall@.25. On SGM1k, DINOv3 gave the strongest overall results, with 90.97% AUC, 86.28% sensitivity, 82.00% specificity, 27.04% mAP@.5, and 77.32% recall@.25. These findings suggest that backbone quality is a critical factor in effective multi-task mammography, with ConvNeXtV2 emerging as a particularly strong and well-matched CNN backbone for mammography in this framework.

Re-thinking Mammography Transfer Learning: The Dataset-Informed Transfer Learning (DITL) Framework for Breast Cancer Screening and Lesion Diagnosis

Enhancing classification performance in mammography remains a persistent challenge across both small curated datasets and large-scale clinical cohorts. Conventional transfer learning approaches often neglect dataset-specific characteristics, while recent neighborhood-informed methods have been restricted to narrow tasks with rigid formulations, limiting their scalability to population-level datasets. To address these challenges, we propose the Dataset-Informed Transfer Learning (DITL) framework, which integrates dataset-derived difficulty signals with neighborhood-based triplet supervision in a unified objective. DITL introduces two adaptive components: (i) Adaptive Difficulty-Weighted Cross-Entropy (A-DWCE), which assigns per-sample weights based on k-nearest neighbor label purity in a self-supervised feature space, and (ii) Adaptive Neighborhood Representation Triplet (A-NR-Triplet), which enforces intra-class compactness and inter-class separation using a learnable margin. Unlike focal loss, DITL requires no hyperparameter tuning, removes heuristic weighting and fixed margins, and incurs negligible computational overhead, yielding a robust and scalable optimization strategy. On the large-scale VinDR-Mammo dataset, DITL achieves state-of-the-art performance for whole-image breast density classification, with significant improvements across accuracy, F1-score, and AUC (p < 0.0001). Beyond large cohorts, DITL also delivers consistent, statistically significant gains on small ROI datasets (p < 0.0001). By bridging small-scale lesion analysis with large-scale density estimation, DITL establishes a clinically relevant, scalable, and generalizable framework for mammography classification, spanning the full breast cancer screening-to-diagnosis spectrum.

Gradient-Based Latent Decomposition Reveals Mechanisms of Feature Degradation in Weakly Supervised Mammography

Weakly supervised hierarchical models exhibit a persistent asymmetry: coarse lesion-type features are preserved under reconstruction while fine-grained malignancy cues degrade---a pattern with direct consequences for the clinical reliability of breast cancer screening pipelines. We introduce gradient-based orthogonal latent decomposition for hierarchical Variational Autoencoders~(H-VAEs) to mechanistically explain this asymmetry. The latent space is partitioned into a task-aligned component~($z_1$), shaped by coarse supervisory gradients, and an orthogonal residual~($z_{\text{res}}$) capturing remaining representational capacity. On~3,550 mammographic Regions of Interest~(ROIs) from CBIS-DDSM, only~$\sim$4.4\% of latent magnitude aligns with supervisory gradients, leaving~$\sim$95.6\% in the orthogonal residual upon which fine-grained pathology prediction primarily depends. The model achieves Stage-1~AUC~0.866 and Stage 2~AUC~0.552, with a reconstruction stability gap of $Δ_{\text{diag}}=5\%$ ($p=0.005$) and a classification gap of $Δ_{\text{AUC}}=0.314$ ($p{<}0.001$). Latent ablation confirms that features for both tasks reside heavily in~$z_{\text{res}}$, structurally explaining why reconstruction degrades pathology stability disproportionately. Comparisons with Multi-Instance Learning~(MIL) and Multi-Task Learning~(MTL) confirm generalization across architectures and modalities. These findings reveal that in high-dimensional spaces, a single coarse supervisory signal isolates only a sparse 1D latent direction, forcing critical fine-grained features into the vulnerable residual subspace.

A Diagnostic Gap Framework for Evaluating Reconstruction Fidelity in Weakly Supervised Mammography

Weakly supervised pipelines for medical imaging have become increasingly popular over the years. These systems often include multiple stages and components, such as reconstruction, generation, and localization, yet standard evaluation metrics provide limited insight into whether clinically relevant information is preserved across each stage. We present the diagnostic gap framework, a practical evaluation tool that measures decision preservation and explanation preservation as a function of measured reconstruction fidelity. To isolate the effect of reconstruction from localization, we evaluate on curated lesion ROI crops using a fidelity ladder of three class-conditional reconstructors---VQ-VAE-GAN, VAE-GAN, and diffusion (SDEdit)---spanning a twenty-fold range in perceptual distance (LPIPS 0.029--0.584). At autoencoder fidelity, both decision and explanation are preserved: AUC changes remain within $\pm$0.005 and attribution similarity (HiResCAM, Grad-CAM++) stays high. At diffusion fidelity, both collapse: pooled AUC drops by 0.253 and mass-pathology AUC falls below chance. The diagnostic gap is thus a measurable function of reconstruction fidelity rather than an intrinsic cost of reconstruction, and the framework provides an architecture-agnostic instrument for identifying when and where multi-stage pipelines lose diagnostic signal.

Region-Grounded Vision-Language Learning for Detection-Guided Mammographic Lesion Classification

Vision-language models trained with contrastive objectives have shown promise in medical image analysis. However, conventional global image-text alignment is ill-suited for mammography, where diagnostically relevant lesions are spatially localized and occupy only a small fraction of the image. Subtle morphological cues critical for malignancy assessment can be diluted when representations are learned at the whole-image level. In this work, we propose a novel region-grounded vision-language learning method for detection-guided mammographic lesion classification. The method mirrors radiologists' diagnostic paradigm. First, a region-text contrastive pretraining stage aligns lesion-specific features with structured clinical descriptors derived from radiology metadata. To mitigate semantic collapse and background bias in low-vocabulary settings, we introduce a multi-component objective incorporating positive alignment, fine-grained semantic hard negatives, and background suppression. Second, an auxiliary lesion detection head is jointly optimized with contrastive classification to preserve spatial sensitivity and enable localization-aware malignancy classification. Extensive experiments on two independent datasets, CBIS-DDSM and VinDr-Mammo, show superior performance of our method compared to related methods under in-domain, cross-dataset, and transfer learning settings.

Dataset-Origin Signatures and Shortcut Learning in Screening Mammography AI: A Cross-Dataset Case Study

Reliable AI for screening mammography requires training data representative of the low cancer prevalence and subtle abnormalities found in screening populations. We examined whether supplementing such data with biopsy-confirmed cases from abnormal-enriched external datasets improves performance. Using the Newfoundland and Labrador Breast Screening Dataset (NLBSD) alongside CBIS-DDSM and CMMD, we evaluated an EfficientNet-B5 encoder initialized with Mammo-CLIP weights as a frozen linear probe under consistent preprocessing and patient-level splits. The NLBSD-only model achieved an AUC-ROC of 0.737 (95% CI [0.686, 0.785]). Adding external positive cases reduced performance in every configuration (AUC-ROC = 0.620--0.644; DeLong test, Holm-corrected $p < 0.05$), with degradation increasing as additional sources were introduced. Domain-matched evaluation produced modest gains only when the training and test domains coincided, and no configuration surpassed the NLBSD-only model. As a diagnostic, we reframed the task as predicting each examination's dataset of origin. The datasets were separated almost perfectly despite identical preprocessing, indicating that dataset-specific characteristics strongly influence the learned representation. These findings show that naïvely pooling abnormal-enriched mammography datasets can introduce domain shift that outweighs the benefit of additional positive cases. Differences in acquisition, intensity mapping, and dataset construction persist after normalization, motivating domain-aware strategies for combining heterogeneous mammography datasets.

Longitudinal Multi-View Breast Cancer Risk Prediction

Accurate breast cancer risk prediction from screening mammography is critical for enabling personalized screening intervals and early detection. Recent deep learning methods have shown the value of longitudinal data and explicit temporal alignment. However, existing approaches either perform explicit alignment using a single mammographic view or model multiple views without explicit longitudinal alignment, limiting their ability to exploit the complementary spatial-temporal information used in clinical practice. To address this gap, we propose LMV-Net, a longitudinal multi-view breast cancer risk prediction model that jointly analyzes anatomically complementary CC and MLO views within an explicitly aligned longitudinal framework. We evaluate our approach on the public EMBED and CSAW-CC datasets, comparing it to state-of-the-art breast cancer risk prediction methods. Our model consistently outperforms existing approaches in overall risk prediction performance and across different breast density and cancer subgroups. Importantly, these improvements highlight the potential of longitudinal multi-view modeling to enhance risk stratification, paving the way for future work on personalized screening, earlier identification of high-risk patients, and more efficient screening resource allocation. The code is available at https://github.com/sot176/LMV-Net.

Pitfalls of Administrative Censoring in Survival Models with Time-Indexed Inputs

Survival models can model time-to-event outcomes using partially observed data. They are widely used in clinical prediction, including cancer risk, disease progression, treatment response, and mortality. Recent models often rely on rich inputs collected at a specific clinical encounter, such as medical images, laboratory tests, electronic health record snapshots, or sensor measurements. In large retrospective datasets, these inputs are usually collected over many calendar years. As a result, they may contain clues about when they were acquired through changes in devices, protocols, documentation, patient mix, or clinical practice. This creates a potential failure mode when outcomes are observed only up to a fixed study end date. More recent records necessarily have less potential follow-up than older records. A model that can infer the record date from the input may therefore learn to predict how much follow-up was available rather than the patient's true risk of experiencing the event. We call this failure mode administrative-cutoff leakage. In this paper, we characterize when this leakage can occur, distinguish it from classical informative censoring and genuine temporal changes in risk, and propose practical ways to detect it. In simulations, we show that administrative-cutoff leakage can inflate fixed-horizon AUC and can also affect Harrell's C-index under realistic follow-up patterns. We then demonstrate the same behavior in a real mammography cohort. These results motivate a simple design principle for survival prediction: for an n-year prediction task, the dataset should provide at least n years of potential follow-up after the latest input date. Otherwise, the models may be subject to bias induced by administrative-cutoff leakage.

Benchmarking the Robustness of Foundation Models for Mammography under Domain Shift

Foundation models are increasingly used as image feature extractors for mammography, but their robustness under external domain shift remains unclear. We benchmark 15 foundation-model backbones across breast density, BI-RADS severity, and cancer status using a unified frozen-backbone linear-probe protocol, training on 3 source datasets and evaluating on 12 task-compatible out-of-distribution (OOD) datasets after label harmonization. Mammography-specific vision-language models (Mammo-FM and MaMA) provide the strongest mean OOD performance, but robustness is not explained by mammography exposure alone. DINOv3 remains a competitive vision-only baseline, and mammography-adapted pretraining does not consistently improve generalization. Dataset-level analysis further shows that even leading models show heterogeneous performance across datasets. Feature-space inspection reveals that useful representations can preserve clinical signal while retaining dataset and acquisition structure. These findings highlight dataset-level OOD evaluation as a central criterion for assessing mammography representations. Our code is publicly available: https://github.com/biomedia-mira/mammo-ood.

BiLoG-Net: A Bi-Context Location-Guided Network for Breast Mass Segmentation and Malignancy Classification in Mammography

Breast cancer remains the most commonly diagnosed malignancy among women worldwide, yet accurate detection and characterization of breast masses in mammography remain challenging due to subtle intensity variations, heterogeneous tissue densities, and indistinct lesion boundaries that complicate radiological interpretation. To address these limitations, we propose BiLoG-Net, a deep learning framework that jointly performs breast mass segmentation and malignancy classification through bi-context location-aware feature modeling and segmentation-guided attention mechanisms. Our architecture integrates a novel encoder-decoder paradigm with Fire-based feature extraction, lightweight global and local feature enhancement modules, and adaptive location-aware gating to simultaneously capture long-range contextual dependencies and fine-grained boundary-sensitive details. Unlike conventional multi-stage pipelines, our tightly coupled multi-task design enables mutual reinforcement between pixel-level localization and image-level diagnosis, reducing error propagation while producing spatially grounded malignancy predictions. Evaluated on CBIS-DDSM and INBreast benchmarks, BiLoG-Net achieves state-of-the-art performance with Dice scores of 94.20% and 93.10%, classification accuracies of 95.20% and 93.60%, and AUC values of 97.10% and 96.00%, respectively, substantially outperforming existing CNN and transformer-based baselines. By combining precise boundary delineation with reliable malignancy assessment in a single end-to-end model, this work holds strong potential for clinical computer-aided detection systems, helping radiologists prioritize suspicious cases and improve screening efficiency in busy clinical settings.

Unsupervised Domain Adaptation for Calcification Classification in Mammography Across Multi-Site Datasets

Deep learning-based computer-aided diagnosis (CAD) systems have shown strong performance in breast cancer diagnosis, particularly for classification tasks in mammography. However, domain shifts across multi-site datasets remain a challenge, especially when models are applied to unseen domains. In this work, we proposed a calcification classification framework to improve malignant versus benign breast disease classification across multi-site mammography datasets. The framework consisted of two components: (1) an unsupervised domain adaptation module based on style transfer models (AdaIN and CycleGAN) to generate vendor-specific and technique-specific training samples without additional annotations, and (2) a supervised classification module using Swin Transformer V2 as the backbone. We evaluated the proposed method on three datasets: cross-validation on OPTIMAM (National Health Service, United Kingdom; n=2994), followed by external validation on EMBED (Emory University; n=125), and Duke Calcification Dataset v1 (n=788). These datasets cover multiple vendors and include both full-field digital mammography and synthetic 2D images derived from digital breast tomosynthesis. The proposed framework improved cross-site performance for both EMBED (AUC 0.68 to 0.72) and the Duke Calcification Dataset (AUC 0.68 to 0.73). These findings indicate that domain adaptation can reduce domain shifts and improve the generalization for calcification classification across multi-site datasets.

Token-Based Dual-view Fusion and Adaptation of Large Vision Models for Breast Cancer Classification

Accurate breast cancer classification from mammography requires effective integration of complementary information from craniocaudal (CC) and mediolateral oblique (MLO) views, which provide a more complete characterization of breast abnormalities. However, existing multi-view learning approaches typically rely on feature-level aggregation or single-stage cross-attention, which can entangle view-specific and shared representations and restrict interaction to limited network depths. To address these limitations, we propose a token-centric dual-view learning framework that unifies prompt-based adaptation and cross-view fusion within a frozen vision transformer backbone. The framework reformulates inter-view interaction as structured token-level communication, where dedicated fusion tokens explicitly encode bidirectional information exchange between CC and MLO views via cross-attention, serving as intermediate carriers of cross-view dependencies rather than relying on direct feature fusion. Unlike conventional methods that apply fusion at a single layer, fusion modules are inserted at multiple transformer depths, enabling progressive and repeated interaction across the encoder hierarchy. Fusion tokens are reintegrated into the token sequence and refined by subsequent transformer layers, facilitating hierarchical propagation of complementary information while preserving view-specific structure. Experiments on VinDr-Mammo and CMMD datasets demonstrate consistent improvements over linear probing, prompt-only adaptation, and conventional fusion baselines. On the VinDr-Mammo BI-RADS classification task, the framework achieves 50.40% F1-score and 0.8090 AUC, including a 0.10 AUC improvement over a dual-view fusion baseline in the binary setting. Ablation studies further validate the effectiveness of token-based fusion and multi-depth interaction design.

AEGIS: A Multi-Task Joint-Embedding Predictive Architecture for Mammography

We present Aegis, a joint-embedding predictive architecture for breast cancer detection and density assessment in mammography. We train three Vision Transformer variants (Small/Base/Large) using self-supervised joint-embedding predictive architecture (JEPA) pre-training on 71,103 studies from 14 clinical sites, followed by supervised fine-tuning with progressive resolution scaling up to 2048x1536. On a curated 785-study test set, our largest model achieves area under the receiver operating characteristic curve (AUC) 0.949 for breast cancer triage with 93% sensitivity and 75% specificity at the optimal operating point. An ensemble combining our model with a U.S. Food and Drug Administration-cleared baseline further improves discrimination to 0.952 AUC. For breast density classification, the model achieves 0.953 AUC for binary (dense vs. non-dense) classification and 62.6% exact accuracy across four Breast Imaging Reporting and Data System (BI-RADS) categories, with 98.8% adjacent accuracy comparable to reported human inter-reader agreement. External validation on the public VinDr-Mammo dataset provides evidence of cross-population transfer under a different reference standard, with the largest model achieving 0.871 AUC for triage in a zero-shot setting.

MammoFlow: Multiview Mammogram Synthesis with Anatomically Consistent Flow Matching

Multiview mammography relies on paired craniocaudal (CC) and mediolateral oblique (MLO) views to provide complementary projections of a 3D breast volume, enabling precise anomaly localization. However, acquiring high-quality, balanced datasets remains challenging for deep learning applications. We propose a novel method to synthesize multiview mammograms by leveraging the inherent geometric relationship between CC and MLO views. To enforce an implicit 3D consistency prior during generation, we develop an alignment module that searches a 2D affine transformation subspace to establish optimal anatomical correspondence. Leveraging this alignment, we introduce a pixel-space self-consistency loss based on the Earth Mover's Distance (EMD) between the 1D anteroposterior (AP) axis tissue distributions of the generated images. Integrated into a pretrained flow matching model, MammoFlow forces synthesized pairs to share physically plausible tissue distributions from the chest wall to the nipple. To our knowledge, this is the first work to guide multiview mammogram generation using implicit geometric tissue correspondence. Our method demonstrates superior image quality, passes expert radiologist evaluation, and generates physically consistent pairs that improve downstream classification AUC by 5%. Code is available at https://github.com/XYPB/MammoFlow

Revealing Mammographic Phenotypes in Deep Learning Breast Cancer Risk Models

Mammogram-based deep learning models have improved breast cancer risk prediction, but the learned imaging patterns remain underexplored. Existing interpretability methods rely on single-image saliency maps, failing to identify recurring mammographic phenotypes across large patient cohorts. By clustering patch embeddings from a pre-trained model, Mirai, we isolate recurring phenotypes linked to 5-year cancer risk. Analyses show risk-increasing phenotypes capture complex structures (e.g., dense tissue, microcalcifications) and shortcut artifacts (e.g., clips). These phenotypes correlate strongly with older age and higher BI-RADS density. Our framework connects tissue patterns to AI risk scores, revealing clinical signatures and potential latent model confounders.

MammoExpert: Benchmarking Chain-of-Thought Reasoning in Mammography Diagnosis

Mammography is an essential tool for breast cancer detection, with millions of examinations conducted annually. However, publicly available high-quality mammography datasets for AI development remain limited in both scale and annotation richness, particularly regarding pathological subtype coverage and structured diagnostic reasoning annotations. In this paper, we present MammoExpert, the first mammography dataset with Chain-of-Thought reasoning annotations across three diagnostic phases: (i) primal observation, (ii) factual assessment, and (iii) diagnostic synthesis. Comprising 2,379 mammography images covering 67 WHO-classified histopathology subtypes, each exam provides 42 radiographic features annotated by nine senior radiologists. We evaluate its performance on the breast lesion classification task, demonstrating superior accuracy and reasonability compared to existing classification models. Combining public dataset CBIS-DDSM with MammoExpert yields 7.1\% classification accuracy improvement, while the training model to learn CoT reasoning achieves another 4\% gain on the MammoExpert test set. Similar improvements are observed on INBreast and Vindr datasets, where the full approach yields accuracy gains of 6.9\% and 6.7\%, respectively. MammoExpert can serve as a benchmark for interpretable breast lesion diagnosis through explicit CoT reasoning.

OTCHA: Optimal Transport-driven Confidence-aware Latent Hub Alignment for Multi-View Medical Image Classification

Multi-view imaging, such as mammography and chest radiography, is a standard component of clinical practice. However, medical images are often unregistered and contain view-specific artifacts or irrelevant background cues that can obscure diagnostically relevant findings. Many existing methods directly fuse per-view representations, allowing such irrelevant content to contaminate the fused embedding and reducing robustness under varying view configurations. We propose OTCHA, a confidence-aware latent hub token alignment module based on optimal transport (OT) that refines patch tokens before fusion for multi-view classification. OTCHA introduces a set of learnable latent hub tokens shared across views. For each view, we compute an OT plan between patch tokens and hub tokens that jointly considers feature similarity and geometry, and augment the OT formulation with token-conditional dustbins to enable partial matching and discard irrelevant tokens. The resulting transport plan provides token-wise matching confidence, which gates hub-mediated message passing and weights a novel optimal-transport-based representation alignment loss to stabilize refinement. Experiments on three multi-view medical image datasets demonstrate consistent improvements over competing baselines across diverse anatomies and view configurations. Our code is available at https://github.com/labhai/OTCHA.

DSU-Net: An Attention-Enhanced Dense Skip U-Net for Breast Lesion Segmentation in Mammographic Images

Breast cancer remains one of the leading causes of cancer-related mortality among women worldwide, making early detection essential for effective treatment. Mammography is the primary screening modality; however, accurate delineation of suspicious lesions remains challenging and subject to inter-observer variability. Automated segmentation methods can assist radiologists by providing consistent and efficient lesion localization. This study presents DSU-Net, an attention-enhanced Dense Skip U-Net architecture for automated breast lesion segmentation in mammographic images. The proposed framework integrates dense skip connections and attention mechanisms to improve feature propagation, preserve spatial information, and enhance lesion boundary delineation. Experiments were conducted using the Curated Breast Imaging Subset of the Digital Database for Screening Mammography (CBIS-DDSM). To address severe foreground-background imbalance, a composite loss function combining Dice loss, focal loss, and binary cross-entropy loss was employed during training. The proposed model achieved a Dice Similarity Coefficient of 0.9421, an Intersection over Union of 0.8905, an accuracy of 0.9711, and an AUC-ROC of 0.9878 on the validation dataset. Qualitative evaluation demonstrated accurate delineation of lesions with varying sizes and morphologies, while quantitative results confirmed robust discrimination between lesion and background regions. These findings demonstrate that DSU-Net provides accurate and reliable breast lesion segmentation in mammographic images and highlights the potential of attention-guided deep learning for computer-aided breast cancer screening and diagnosis.