Cross-Sensor and Cross-Population Generalization of Deep Learning Models for Digital Mammography: A Controlled Four-Country Benchmark of Five Backbone Architectures with Statistical Significance Testing.

BACKGROUND/

objectivesDeep learning models for digital mammography sensor data are increasingly deployed across hospitals using different X-ray detector technologies and patient populations. Whether models trained on one sensor platform and population maintain accuracy when transferred to another has not been tested for the latest generation of mammography-specific foundation models under one controlled protocol.

methodsWe fine-tuned five backbone architectures (ResNet-50, DINOv2-B14, Rad-DINO, Mammo-CLIP B5, and Mammo-FM) on CBIS-DDSM (film-digitized, USA,

resultsWithin this single-source three-seed evaluation, ResNet-50 outperformed all four foundation models on CBIS-DDSM (AUC 0.867 vs. 0.847, 0.846, 0.813, and 0.703; all gaps

conclusionsIn this single training-source, three-seed protocol, mammography-specific pretraining did not deliver the in-distribution AUC premium reported in the originating papers, and no architecture reached a level at which transfer deployment without local validation would be defensible. We frame these as observations specific to the present protocol rather than as broader conclusions about foundation models for mammography classification. The findings argue for sensor-stratified and population-stratified external validation and for local recalibration as practical prerequisites before clinical use. Code and weights are released under MIT license.