Purpose: To differentiate oncocytoma and chromophobe renal cell carcinoma (RCC) using radiomics features computed from spherical samples of image regions of interest, “radiomic biopsies” (RBs).

Approach: In a retrospective cohort study of 102 CT cases [68 males (67%), 34 females (33%); mean age ± SD, 63  ±  12  years], we pathology-confirmed 42 oncocytomas (41%) and 60 chromophobes (59%). A board-certified radiologist performed two RB rounds. From each RB round, we computed radiomics features and compared the performance of a random forest and AdaBoost binary classifier trained from the features. To control for overfitting, we performed 10 rounds of 70% to 30% train-test splits with feature-selection, cross-validation, and hyperparameter-optimization on each split. We evaluated the performance with test ROC AUC. We tested models on data from the other RB round and compared with the same round testing with the DeLong test. We clustered important features for each round and measured a bootstrapped adjusted Rand index agreement.

Results: Our best classifiers achieved an average AUC of 0.71  ±  0.024. We found no evidence of an effect for RB round (p  =  1). We also found no evidence for a decrease in model performance when tested on the other RB round (p  =  0.85). Feature clustering produced seven clusters in each RB round with high agreement (Rand index  =  0.981  ±  0.002, p  <  0.00001).

Conclusions: A consistent radiomic signature can be derived from RBs and could help distinguish oncocytoma and chromophobe RCC.