Quantitative Ultrasound (QUS) represents an emerging non-invasive imaging approach designed to monitor treatment responses. Research has demonstrated a strong association between QUS backscatter metrics and microscopic structural changes, as variations in ultrasound backscatter parameters significantly reflect increased cell death. Specifically, indicators related to scatterer size and concentration tend to rise with cellular degeneration. Numerous preclinical and clinical investigations have explored the role of QUS in assessing tumor response. Preclinical studies primarily applied QUS to distinguish viable from non-viable cells by assessing cell death dynamics, whereas clinical studies have mainly utilized it for tissue characterization—such as differentiating benign from malignant breast tumors and identifying patients who respond to therapy from those who do not. This review outlines key insights from previous experimental and clinical research, emphasizing the growing clinical potential and therapeutic advantages of QUS. Furthermore, it provides an overview of recent progress in ultrasound-based radiomics for predicting and tracking treatment outcomes, as well as for classifying breast lesions, and addresses the existing limitations, challenges, and future directions of QUS-radiomics in oncology.
