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

Zhengbo Zhou; Jiren Li; Dooman Arefan; Margarita Zuley; Shandong Wu

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arXiv · 2607.15615

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

Zhengbo Zhou·Jiren Li·Dooman Arefan·Margarita Zuley·Shandong Wu

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Abstract

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.

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Zhengbo Zhou, Jiren Li, Dooman Arefan, Margarita Zuley, Shandong Wu. 2026-07-17. Region-Grounded Vision-Language Learning for Detection-Guided Mammographic Lesion Classification. https://arxiv.org/abs/2607.15615

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