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Baseline and Early-Delta Quantitative Ultrasound Radiomics for Predicting Pathologic Response to Neoadjuvant

Ramona Putin¹, Livia Stanga², Ciprian Ilie Roșca³

¹Doctoral School, Faculty of Medicine, Vasile Goldis Western University of Arad, 310414 Arad, Romania.

Journal of Clinical Medicine

|May 27, 2026

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Quantitative ultrasound (QUS) radiomics can predict breast cancer response to neoadjuvant chemotherapy (NAC). Early changes in QUS features at week 2 strongly correlate with pathologic response, aiding treatment decisions.

Area of Science:

Medical Imaging
Oncology
Biomarkers

Background:

Early identification of breast cancer patients benefiting from neoadjuvant chemotherapy (NAC) is crucial to avoid ineffective treatments and toxicity.
Quantitative ultrasound (QUS) radiomics offers a non-invasive method to extract imaging biomarkers from ultrasound data.

Purpose of the Study:

To evaluate if baseline QUS radiomic features and early treatment-induced changes can predict pathologic response to NAC.
To assess the potential of QUS radiomics as an early biomarker for treatment response in breast cancer.

Main Methods:

Prospective observational study of 96 women with stage II-III breast cancer undergoing NAC.
Standardized QUS examinations before treatment and at week 2.
Pathologic response defined by residual cancer burden (RCB) class at surgery; multivariable logistic regression used for prediction analysis.

Keywords:

breast neoplasms machine learning neoadjuvant therapy radiomics ultrasonography

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Main Results:

Forty-three patients (44.8%) were responders. Responders showed distinct baseline QUS features and significant early changes (week 2) in mid-band fit, entropy, and spectral intercept.
Multivariable analysis identified changes in mid-band fit and entropy as independent predictors of response.
A combined clinical-plus-QUS model achieved an AUC of 0.89.

Conclusions:

Baseline microstructural heterogeneity and very early QUS-derived treatment changes are strongly associated with pathologic response to NAC.
QUS radiomics shows potential as a cost-effective and repeatable early-response biomarker for breast cancer treatment.