Fatma Hilal Yagin ^1* Yasin GÖRMEZ ² Fahaid AL-Hashem ³ Irshad Ahmad ⁴ Fuzail Ahmad ⁵ Luca Paolo Ardigò ^6*

• ¹ Department of Biostatistics and Medical Informatics, Faculty of Medicine, Inonu University, Malatya, Türkiye
• ² Other, Sivas, Türkiye
• ³ Department of Physiology, College of Medicine, King Khalid University, Abha, Saudi Arabia
• ⁴ Department of Medical Rehabilitation sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
• ⁵ College of Applied Sciences, University of Almaarefa, Dariyah, Riyadh, Saudi Arabia
• ⁶ Department for Teacher Education, NLA University College, Oslo, Norway

Background: Breast cancer (BC) is a significant cause of morbidity and mortality in women. Although the important role of metabolism in the molecular pathogenesis of BC is known, there is still a need for robust metabolomic biomarkers and predictive models that will enable the detection and prognosis of BC. This study aims to identify targeted metabolomic biomarker candidates based on explainable artificial intelligence (XAI) for the specific detection of BC. Methods: Data obtained after targeted metabolomics analyses using plasma samples from BC patients (n = 102) and healthy controls (n = 99) were used. Machine learning (ML) models based on raw data were developed, then feature selection methods were applied, and the results were compared. SHapley Additive exPlanations (SHAP), an XAI method, was used to clinically explain the decisions of the optimal model in BC prediction. Results: The results revealed that variable selection increased the performance of ML models in BC classification, and the optimal model was obtained with the logistic regression (LR) classifier after support vector machine (SVM)-SHAP-based feature selection. SHAP annotations of the LR model revealed that Leucine, isoleucine, L-alloisoleucine, norleucine, and homoserine acids were the most important potential BC diagnostic biomarkers. Combining the identified metabolite markers provided robust BC classification measures with precision, recall, and specificity of 89.50%, 88.38%, and 83.67%, respectively. Conclusions: In conclusion, this study adds valuable information to the discovery of BC biomarkers and underscores the potential of targeted metabolomics-based diagnostic advances in the management of BC.