Role of radiomics in predicting early disease recurrence in locally advanced breast cancer patients: integration of radiomic features and RECIST criteria

Background: Breast cancer (BC) is a major global health issue with significant heterogeneity among its subtypes. Neoadjuvant treatment (NAT) has been extended to include early BC patients, particularly those with HER2 + and triple-negative subtypes, to achieve pathological complete response and improve long-term outcomes. However, disease recurrence remains a challenge, highlighting the need for predictive biomarkers. This study evaluates the role of radiomics from pre-treatment breast MRI, integrated with clinical and radiological variables, in predicting early disease recurrence (EDR) after NAT. Methods: A retrospective analysis was conducted on 238 BC patients treated with NAT and assessed using pre- and post-treatment breast MRI. Radiomic features were extracted and combined with clinical and radiological data to develop predictive models for EDR. Models were evaluated using AUC, accuracy, sensitivity, and specificity metrics. Results: The radiological-radiomic model, which integrated pre-treatment MRI radiomics with RECIST response data, demonstrated the highest predictive performance for EDR (AUC 0.77, sensitivity 0.85). Internal validation confirmed the robustness of the model. Conclusion: Combining radiomic features from pre-NAT MRI with RECIST response evaluation from post-NAT MRI enhances the prediction of EDR in BC patients, supporting precision medicine in treatment strategies and follow-up planning. Further validation on larger cohorts is needed to confirm these findings.