Early prediction of neoadjuvant chemotherapy efficacy among patients with triple-negative breast cancer using an ultrasound-based radiomics nomogram

Abstract

Purpose: To develop and validate a radiomics nomogram based on early ultrasound (US) imaging for predicting pathologic complete response (pCR) in patients with triple-negative breast cancer (TNBC) receiving neoadjuvant chemotherapy (NAC).

Methods: This retrospective study included 328 patients with TNBC treated between September 2019 and January 2024, divided into a training cohort (n = 230) and a validation cohort (n = 98). Clinicopathologic data, US features before NAC, tumor volume reduction (TVR) after two cycles of NAC, and radiomics features were collected. Multiple logistic regression was applied to identify the potential predictors of pCR. The efficacy of the nomogram was evaluated through the receiver operating characteristic, calibration, and decision curve analyses. The study was approved by the ethics committee on February 28, 2024, with approval number 2023-SR-799, and the requirement for informed consent was waived.

Results: Twelve features were selected to construct the radiomics signature (RS). The nomogram, incorporating tumor histologic grade, TVR, and RS, yielded an area under the curve of 0.856 [95% confidence interval (CI), 0.807-0.905] in the training cohort and 0.836 (95% CI, 0.749-0.923) in the validation cohort, outperforming both the clinico-ultrasonic and RS models. The calibration and decision curves confirmed the nomogram's excellent calibration and clinical utility.

Conclusion: The nomogram, which includes US characteristics, clinical variables, and radiomics features, exhibited satisfactory performance in predicting NAC efficacy in patients with TNBC.

Clinical significance: The US-based radiomics nomogram, incorporating histologic grade, TVR, and RS, shows preliminary clinical application potential for predicting NAC efficacy in patients with TNBC.

Keywords: Triple-negative breast cancer; neoadjuvant chemotherapy; pathologic complete response; radiomics; ultrasonography.