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Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
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
Core Tip

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.