Wu YX, Tian R, Li XW, Guo JY, Tang JF, Zhou CF. Emerging non-invasive imaging biomarkers of Ki-67 in pancreatic cancer: Toward predictive precision oncology. World J Gastrointest Oncol 2025; 17(11): 110468 [DOI: 10.4251/wjgo.v17.i11.110468]
Corresponding Author of This Article
Ce-Fan Zhou, PhD, Professor, School of Life and Health Sciences, Institute of Biomedical Research, National “111” Center for Cellular Regulation and Molecular Pharmaceutics, Key Laboratory of Fermentation Engineering (Ministry of Education), Hubei University of Technology, No. 28 Nanli Road, Wuhan 430068, Hubei Province, China. cefan@hbut.edu.cn
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Editorial
Open-Access Policy of This Article
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/
Yi-Xin Wu, Rui Tian, Xiao-Wen Li, Jie-Yu Guo, Jing-Feng Tang, Ce-Fan Zhou, School of Life and Health Sciences, Institute of Biomedical Research, National “111” Center for Cellular Regulation and Molecular Pharmaceutics, Key Laboratory of Fermentation Engineering (Ministry of Education), Hubei University of Technology, Wuhan 430068, Hubei Province, China
Author contributions: Wu YX wrote the original draft; Zhou CF and Tang JF contributed to the conceptualization, writing, review, and editing of the manuscript; Tian R, Li XW, and Guo JY provided some valuable opinions. All authors have reviewed and approved the final version of the manuscript.
Supported by the National Key R&D Program of China, No. 2023YFC2507900; the National Natural Science Foundation of China, No. 32270768, No. 82273970, and No. 82370715; the Innovation Group Project of Hubei Province, No. 2023AFA026; the Key Cultivation Project of Hubei Province for Science and Technology, No. 2024DJA037; and the National Natural Science Foundation of Hubei, No. 2025AFA085.
Conflict-of-interest statement: All the authors report 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: Ce-Fan Zhou, PhD, Professor, School of Life and Health Sciences, Institute of Biomedical Research, National “111” Center for Cellular Regulation and Molecular Pharmaceutics, Key Laboratory of Fermentation Engineering (Ministry of Education), Hubei University of Technology, No. 28 Nanli Road, Wuhan 430068, Hubei Province, China. cefan@hbut.edu.cn
Received: June 10, 2025 Revised: July 5, 2025 Accepted: September 22, 2025 Published online: November 15, 2025 Processing time: 160 Days and 14.5 Hours
Abstract
The proliferative index of Ki-67 in pancreatic ductal adenocarcinoma (PDAC) exhibits strong correlations with tumor progression and prognosis, holding significant clinical implications. Yang et al employed contrast-enhanced ultrasound (CEUS) to indirectly evaluate neovascularization in pancreatic cancer lesions. Specific CEUS parameters demonstrated significant diagnostic value in assessing Ki-67 expression. The falling slope 50% achieved an area under the curve of 0.838. Meanwhile, the rise slope 10%-90% exhibited superior overall diagnostic accuracy (area under the curve = 0.863), showing a sensitivity of 0.92 and a moderate specificity of 0.759. These values demonstrate specificity in differentiating between low and high Ki-67 expression groups. This study effectively addresses the critical need for a non-invasive assessment of pancreatic cancer aggressiveness via Ki-67 expression. These findings strongly support the translational potential of CEUS biomarkers for non-invasive Ki-67 assessment and treatment stratification in PDAC. While Yang et al demonstrated exhibited encouraging methodologies, its retrospective design, modest sample size, and single-center nature may impede generalizability, pending validation in multi-institutional cohorts. We recommend expanding the sample size to enhance representativeness and adopting prospective studies integrating multimodal imaging techniques, such as magnetic resonance imaging and positron emission tomography to improve diagnostic reliability. This study is the first to integrate insights from CEUS, magnetic resonance imaging, and positron emission tomography for Ki-67 expression assessment in PDAC. Building on this innovation, we focus this article on recent advances in the clinical diagnosis of pancreatic cancer, aiming to provide insights for advancing research in this field.
Core Tip: Ki-67 expression levels in tumor cells function as both an early predictor of treatment response and a long-term prognostic factor in cancer patients. In this study, we begin by assessing the limitations of current non-invasive imaging techniques for evaluating Ki-67 in pancreatic cancer. Subsequently, we explore more rational methodological refinements, including prospective studies and combined imaging modalities, with the objective of enhancing predictive accuracy. This discussion also highlights potential future research directions.
