Radiomics Analysis of QUS Spectral Parametric Images for Predicting the Risk of Breast Cancer Recurrence

<b>Background/Objectives:</b> To evaluate the ability of radiomics analysis of QUS spectral parametric imaging to non-invasively differentiate intermediate-to-high-risk from low-risk Oncotype DX^TM Recurrence Score (ODXRS). <b>Methods:</b> This prospective study included 31 participants (21 intermediate-to-high-risk ODXRS (median age, 56 years [IQR: 49-68 years]) and 10 low-risk ODXRS (median age, 52 years [IQR: 48-58 years])) presenting with ER+ HER2- invasive breast masses acquired between September 2015 and August 2024. Quantitative ultrasound (QUS) spectroscopy produced five spectral maps, from which radiomics features (including statistical, texture, and morphological measures) were extracted from the tumor core and a 5 mm margin. The ground truth label was determined from thresholding the ODXRS. A multivariate predictive model was developed to differentiate intermediate-to-high-risk ODXRS from low-risk ODXRS, with performance assessed via nested leave-one-out cross-validation (LOOCV). <b>Results:</b> A nested leave-one-out cross-validation (LOOCV) analysis demonstrated the generalization performance of a four-feature model. The support vector machine (SVM-RBF) classifier achieved 86% recall, 100% specificity, 93% balanced accuracy, and an area under the receiver operating characteristic curve (AUROC) of 0.95 (CI = 0.88-1.00) in identifying intermediate-to-high-risk versus low-risk ODXRS. <b>Conclusions:</b> The preliminary results suggest the potential radiomics-based model of ODXRS in predicting the risks of recurrence. The results warrant further investigation on a larger cohort. This framework can be a useful surrogate for participants for whom ODX testing is neither affordable nor available.