PURPOSE To develop and validate a radiomics nomogram based on early ultrasound (US) imaging for pre - dicting pathologic complete response (pCR) in patients with triple-negative breast cancer (TNBC) receiving neoadjuvant chemotherapy (NAC). METHODS This retrospective study included 328 patients with TNBC treated between September 2019 and January 2024, divided into a training cohort (n = 230) and a validation cohort (n = 98). Clinicopath- ologic data, US features before NAC, tumor volume reduction (TVR) after two cycles of NAC, and radiomics features were collected. Multiple logistic regression was applied to identify the potential predictors of pCR. The efficacy of the nomogram was evaluated through the receiver operating characteristic, calibration, and decision curve analyses. The study was approved by the ethics com- mittee on February 28, 2024, with approval number 2023-SR-799, and the requirement for informed consent was waived. RESULTS Twelve features were selected to construct the radiomics signature (RS). The nomogram, incorpo - rating tumor histologic grade, TVR, and RS, yielded an area under the curve of 0.856 [95% confi- dence interval (CI), 0.807-0.905] in the training cohort and 0.836 (95% CI, 0.749-0.923) in the valida- tion cohort, outperforming both the clinico-ultrasonic and RS models. The calibration and decision curves confirmed the nomogram's excellent calibration and clinical utility. CONCLUSION The nomogram, which includes US characteristics, clinical variables, and radiomics features, exhib - ited satisfactory performance in predicting NAC efficacy in patients with TNBC. CLINICAL SIGNIFICANCE The US-based radiomics nomogram, incorporating histologic grade, TVR, and RS, shows prelimi- nary clinical application potential for predicting NAC efficacy in patients with TNBC.