{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T14:13:32Z","timestamp":1785420812102,"version":"3.56.0"},"reference-count":30,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,5,24]],"date-time":"2026-05-24T00:00:00Z","timestamp":1779580800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004600","name":"Kyungpook National University Hospital","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100004600","id-type":"DOI","asserted-by":"crossref"}]},{"id":[{"id":"https:\/\/ror.org\/04qn0xg47","id-type":"ROR","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003710","name":"Ministry of Health & Welfare, Republic of Korea","doi-asserted-by":"publisher","award":["HR-2022-KH130591"],"award-info":[{"award-number":["HR-2022-KH130591"]}],"id":[{"id":"10.13039\/501100003710","id-type":"DOI","asserted-by":"publisher"}]},{"award":["HR-2022-KH130591"],"award-info":[{"award-number":["HR-2022-KH130591"]}],"id":[{"id":"https:\/\/ror.org\/00vxgjw72","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Bioengineering"],"abstract":"<jats:p>The Oncotype DX\u00ae 21-gene recurrence score (RS) guides adjuvant chemotherapy decisions in estrogen receptor-positive, human epidermal growth factor receptor 2-negative (ER+\/HER2\u2212) breast cancer, yet requires invasive tissue sampling and involves substantial costs. This study evaluated intratumoral tumor ecological diversity (iTED), a habitat imaging approach, as a non-invasive complement for predicting Oncotype DX\u00ae high-risk classification (RS &gt; 25). This retrospective multi-center study included 312 patients with ER+\/HER2\u2212 invasive breast cancer who underwent Oncotype DX\u00ae testing (development: n = 168; external validation: n = 144). The iTED framework employed superpixel-based habitat determination using Gaussian mixture models on pretreatment dynamic contrast-enhanced MRI. Four predictive models were compared: clinical, conventional whole-tumor radiomics (C-radiomics), iTED, and combined (Clinical + iTED). The iTED model achieved higher discriminative performance compared with C-radiomics in both development (area under the curve [AUC]: 0.868 \u00b1 0.068 vs. 0.730 \u00b1 0.112) and external validation (AUC: 0.811 vs. 0.587) sets. The combined model further improved performance (development AUC: 0.908 \u00b1 0.043; external AUC: 0.889). Habitat imaging-based iTED features achieved numerically higher performance than conventional radiomics in predicting Oncotype DX\u00ae high-risk classification. These findings suggest the potential of iTED as a non-invasive imaging biomarker to support molecular testing in clinical decision-making.<\/jats:p>","DOI":"10.3390\/bioengineering13060611","type":"journal-article","created":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T02:32:28Z","timestamp":1779676348000},"page":"611","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Predictions of Oncotype DX\u00ae High-Risk Classification Using Magnetic Resonance Imaging-Based Intratumoral Heterogeneity"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2856-935X","authenticated-orcid":false,"given":"Sung Joon","family":"Park","sequence":"first","affiliation":[{"name":"School of Computer Science and Engineering, Kyungpook National University, Daegu 41566, Republic of Korea"},{"name":"BeamWorks Inc., Daegu 41566, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Won Hwa","family":"Kim","sequence":"additional","affiliation":[{"name":"BeamWorks Inc., Daegu 41566, Republic of Korea"},{"name":"Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaeil","family":"Kim","sequence":"additional","affiliation":[{"name":"School of Computer Science and Engineering, Kyungpook National University, Daegu 41566, Republic of Korea"},{"name":"BeamWorks Inc., Daegu 41566, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taewoo","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Surgery, Pusan National University School of Medicine, Busan 49241, Republic of Korea"},{"name":"Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7571-1064","authenticated-orcid":false,"given":"Ji-Young","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Pathology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Byeongju","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2880-6472","authenticated-orcid":false,"given":"Joon Suk","family":"Moon","sequence":"additional","affiliation":[{"name":"Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ho Yong","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0263-0941","authenticated-orcid":false,"given":"Hye Jung","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1826-1690","authenticated-orcid":false,"given":"Jeeyeon","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1056\/NEJMoa1804710","article-title":"Adjuvant Chemotherapy Guided by a 21-Gene Expression Assay in Breast Cancer","volume":"379","author":"Sparano","year":"2018","journal-title":"N. 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