Moyana TN. Contrast-enhanced ultrasound as a non-invasive diagnostic modality for pancreatic ductal adenocarcinoma: The question of Ki67 for study validation. World J Gastrointest Oncol 2025; 17(10): 110570 [PMID: 41114097 DOI: 10.4251/wjgo.v17.i10.110570]
Corresponding Author of This Article
Terence N Moyana, MD, FRCPC, FCAP, Full Professor, Division of Diagnostic and Molecular Pathology, The Ottawa Hospital and University of Ottawa, 501 Smyth Road, Ottawa K1H 8 L6, Ontario, Canada. tmoyana@toh.ca
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Oncology
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Editorial
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Oct 15, 2025 (publication date) through Oct 26, 2025
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World Journal of Gastrointestinal Oncology
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1948-5204
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Moyana TN. Contrast-enhanced ultrasound as a non-invasive diagnostic modality for pancreatic ductal adenocarcinoma: The question of Ki67 for study validation. World J Gastrointest Oncol 2025; 17(10): 110570 [PMID: 41114097 DOI: 10.4251/wjgo.v17.i10.110570]
World J Gastrointest Oncol. Oct 15, 2025; 17(10): 110570 Published online Oct 15, 2025. doi: 10.4251/wjgo.v17.i10.110570
Contrast-enhanced ultrasound as a non-invasive diagnostic modality for pancreatic ductal adenocarcinoma: The question of Ki67 for study validation
Terence N Moyana
Terence N Moyana, Division of Diagnostic and Molecular Pathology, The Ottawa Hospital and University of Ottawa, Ottawa K1H 8L6, Ontario, Canada
Author contributions: Moyana TN is responsible for all aspects of the work, including conception, design, research, writing, and finalization of the manuscript.
Conflict-of-interest statement: The author reports no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Terence N Moyana, MD, FRCPC, FCAP, Full Professor, Division of Diagnostic and Molecular Pathology, The Ottawa Hospital and University of Ottawa, 501 Smyth Road, Ottawa K1H 8 L6, Ontario, Canada. tmoyana@toh.ca
Received: June 11, 2025 Revised: July 17, 2025 Accepted: August 18, 2025 Published online: October 15, 2025 Processing time: 127 Days and 6 Hours
Abstract
This editorial comments on Yang et al’s article that reported a correlation between dynamic contrast-enhanced ultrasound (CEUS) quantitative parameters and Ki67/tumor differentiation. The validation of CEUS as a diagnostic modality in this study deserves merit. However, it raises interesting points of discussion: (1) Since pancreatic cancer is an overarching term that includes conventional pancreatic ductal adenocarcinoma (PDAC), other subtypes, and neuroendocrine neoplasms (NENs), the inclusion/exclusion criteria require better clarification; (2) Most PDACs are grade 1-2 which contrasts with Yang et al’s study where 46% were grade 3; (3) Ki67 is officially recognized for grading NENs, but not for PDAC; (4) Hotspots are selected for the Ki67 grading of NENs. However, for other tumors (e.g., breast carcinoma), the average count or hotspots are used; (5) There is no agreement for defining high-grade Ki67 cut-off for non-NENs; reports range from 10% to 50%; and (6) Ki67 reflects cellular proliferation but is not always the most important indicator for biologic aggressiveness. That notwithstanding, since the ratification of Ki67 for prognosis in NENs was based on survival outcomes, the real gold standard should be survival, instead of using Ki67 as a surrogate gold standard. In conclusion, the validation of CEUS parameters for PDAC is a work in progress. CEUS is valuable in assessing PDAC but should be viewed as augmenting other modalities such as computed tomography, magnetic resonance imaging, positron emission tomography and endoscopic ultrasound.
Core Tip: Correlations have been reported between contrast-enhanced ultrasound (CEUS) quantitative parameters and Ki67/tumor differentiation. However, the validation process is still a work in progress. Meticulous attention should be paid to subtypes of pancreatic ductal adenocarcinoma selected for testing, the suitability of Ki67 as the gold standard, the counting methodology and grade cut-offs. Overall, CEUS appears valuable in assessing pancreatic ductal adenocarcinoma. However, it should be regarded one more additional tool along with other imaging modalities such as computed tomography, magnetic resonance imaging and positron emission tomography scan. CEUS can also be augmented by endoscopic ultrasound-guided fine needle biopsy for tissue procurement. In certain situations, detective flow imaging endoscopic ultrasonography could be an alternative to CEUS.
