Park SY, Chon HK. Letter to the Editor: Beyond anatomical modeling: Integrating biological and radiomic insights to improve portal-systemic venous invasion prediction. World J Gastroenterol 2026; 32(25): 116974 [DOI: 10.3748/wjg.116974]
Corresponding Author of This Article
Hyung Ku Chon, MD, Professor, Department of Internal Medicine, Wonkwang University College of Medicine, Institute of Wonkwang Medical Science, Wonkwang University Hospital, 895 Muwang-ro, Iksan 54538, Jeonbuk, South Korea. gipb2592@wku.ac.kr
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Gastroenterology & Hepatology
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letter
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Park SY, Chon HK. Letter to the Editor: Beyond anatomical modeling: Integrating biological and radiomic insights to improve portal-systemic venous invasion prediction. World J Gastroenterol 2026; 32(25): 116974 [DOI: 10.3748/wjg.116974]
World J Gastroenterol. Jul 7, 2026; 32(25): 116974 Published online Jul 7, 2026. doi: 10.3748/wjg.116974
Letter to the Editor: Beyond anatomical modeling: Integrating biological and radiomic insights to improve portal-systemic venous invasion prediction
Seung Yong Park, Hyung Ku Chon
Seung Yong Park, Department of Internal Medicine, Jeonbuk National University Medical School, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju 54907, Jeonbuk, South Korea
Hyung Ku Chon, Department of Internal Medicine, Wonkwang University College of Medicine, Institute of Wonkwang Medical Science, Wonkwang University Hospital, Iksan 54538, Jeonbuk, South Korea
Author contributions: Park SY wrote the article and developed methodology; Chon HK designed the study and was involved in data interpretation, assisted in writing the article; all authors have read and approved the final manuscript.
AI contribution statement: AI-based tools such as ChatGPT were used in a limited capacity for language editing and improving clarity of expression during manuscript preparation. The scientific content, study concept, interpretation of data, and overall structure of the manuscript were entirely developed and critically reviewed by the authors. No part of the manuscript was generated solely by AI without substantial human input, revision, and verification. AI tools were not involved in study design, data analysis, or interpretation of results. No images or figures in this manuscript were generated using AI. The authors take full responsibility for the accuracy, integrity, and originality of the manuscript.
Supported by the “Research Base Construction Fund Support Program” funded by Jeonbuk National University in 2025.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Corresponding author: Hyung Ku Chon, MD, Professor, Department of Internal Medicine, Wonkwang University College of Medicine, Institute of Wonkwang Medical Science, Wonkwang University Hospital, 895 Muwang-ro, Iksan 54538, Jeonbuk, South Korea. gipb2592@wku.ac.kr
Received: November 27, 2025 Revised: December 24, 2025 Accepted: January 23, 2026 Published online: July 7, 2026 Processing time: 216 Days and 7.4 Hours
Abstract
Accurate preoperative assessment of portal-systemic venous invasion (PSVI) is essential for treatment planning in borderline resectable pancreatic cancer. The nomogram proposed by Wang et al, published in the recent issue of the World Journal of Gastroenterology, integrating serum carbohydrate antigen 19-9 with computed tomography (CT)-based venous morphometrics, represents an important advance toward objective PSVI estimation. However, anatomical parameters derived from a single baseline assessment may not adequately capture dynamic biological changes during neoadjuvant therapy, thereby limiting predictive accuracy at the time of surgery. Biologic markers obtained via endoscopic ultrasound-guided tissue acquisition, including human equilibrative nucleoside transporter 1, deoxycytidine kinase, and proliferation indices, provide insight into tumor aggressiveness and treatment responsiveness, despite not directly quantifying invasion depth. Artificial intelligence (AI)-driven radiomics and radiogenomics further enable characterization of microstructural vessel-tumor interface features beyond visual assessment. Integrating CT morphometrics with biologic signatures and AI-enhanced imaging may facilitate biologically informed PSVI risk stratification and personalized therapeutic decision-making.
Core Tip: Computed tomography (CT)-based morphologic evaluation remains fundamental for preoperative assessment of portal-systemic venous invasion (PSVI) in borderline resectable pancreatic cancer; however, anatomical metrics alone cannot fully capture tumor biology. Biomarkers obtained through endoscopic ultrasound-guided tissue acquisition, including human equilibrative nucleoside transporter 1 and deoxycytidine kinase, reflect chemosensitivity and proliferative behavior, while artificial intelligence-enabled radiomics characterizes microstructural vessel-tumor interface features beyond conventional imaging. Although these approaches increase cost and analytic complexity and lack universal availability, they should be considered complementary rather than substitutive. Selective integration with CT-based models may further improve PSVI risk stratification.
