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0.23. Two studies [79,80] reported the association between radiomics features and adverse pathological features,
including margin and nodal status, tumor grade, lymphovascular and perineural invasion. Several studies
reported the correlation between radiomics features and clinical outcomes in terms of RFS and OS [81-84] . Few
[85]
data are available on the potential usefulness of radiomics to assess treatment response. Borhani et al. and
Kim et al. reported that textural features extracted from CT could be used as biomarkers predictive of the
[86]
[87]
histologic response, the DFS and the OS after neoadjuvant chemotherapy. Cozzi et al. developed a
clinical-radiomic signature which was significantly associated with OS in PDAC patients treated with
stereotactic body radiation therapy (SBRT) in training and validation cohorts (P = 0.01 and 0.05;
concordance index 0.73 and 0.75, respectively).

CONCLUSION
Radiomics is a promising tool to improve the non-invasive characterization and the preoperative staging of
HBP neoplasms, while the results concerning the prediction of patients’ clinical outcomes are still limited.
Despite these promising results, radiomics is a young discipline and its application is still at the stage of
research. There are several reasons for that, including technical complexity in image analysis, issues in study
design, and lack of standards for image acquisition and validating results. Technical issues in image analysis
and data extraction can be addressed easily through the collaboration between radiologists, computer
scientists and physicists. A possible solution to poor reproducibility would be to establish precise
benchmarks for radiomics studies, including acquisition protocols, and to develop guidelines for results
reporting. Finally, data sharing is a relevant issue, as it includes images and a significant amount of personal
information. A possible solution to overcome cultural, administrative, and regulatory issues is the creation
of centralized data repositories with anonymized data, wherein access can be limited to institutional review
board-approved users.

DECLARATIONS
Authors’ contributions
Made substantial contributions to the conception and design of the study and performed data analysis and
interpretation: De Robertis R, Todesco M
Performed data acquisition: Autelitano D, Spoto F
Scientific guarantor of the study: D’Onofrio M

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.