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Transfer Learning Strategies for Pathological Foundation Models: A Systematic Evaluation in Brain Tumor

Ken Enda¹, Yoshitaka Oda¹, Zen-Ichi Tanei²

¹Department of Cancer Pathology, Faculty of Medicine, Hokkaido University, Sapporo, Japan.

Pathology International

|February 18, 2026

Summary

For brain tumor classification AI, linear probing (LP) with foundation models outperforms fine-tuning (FT) on external data. This approach enhances AI generalization, overcoming limitations of limited hospital case data.

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Area of Science:

Artificial Intelligence in Pathology
Computational Pathology
Machine Learning for Medical Imaging

Background:

Deploying pathology AI in hospitals is challenged by limited case data and adapting pre-trained models.
Brain tumor classification presents a specific challenge due to diverse categories and few institutional cases.
Optimal transfer learning strategies for foundation models in this context are unclear.

Purpose of the Study:

To evaluate fine-tuning (FT) versus linear probing (LP) for brain tumor classification using foundation and conventional AI models.
To determine the most effective transfer learning strategy for adapting AI models to local and external datasets.
To assess the impact of different transfer learning methods on AI model generalization capabilities.

Main Methods:

Compared FT and LP strategies on foundation models (UNI, Prov-GigaPath) and conventional models (ViT-L, CTransPath).
Trained models on an institutional dataset (254 cases) and validated on the EBRAINS dataset (698 cases).
Evaluated performance based on classification accuracy and generalization across datasets.

Main Results:

Conventional models showed FT ≥ LP performance on both datasets.
Foundation models exhibited a reversal: FT marginally outperformed LP on institutional data, while LP significantly outperformed FT on external data (p < 0.01).
UNI with LP (10 patches/case) surpassed fine-tuned conventional models (500 patches/case) on external validation (p < 0.001).

Conclusions:

Fine-tuning foundation models on limited institutional data may lead to overfitting and compromise generalization.
Linear probing preserves pre-trained representations, enabling more efficient AI implementation with superior generalization for brain tumor classification.
Linear probing emerges as a more robust strategy for deploying foundation models in pathology AI with limited local data.