Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jun 15, 2025; 17(6): 107919
Published online Jun 15, 2025. doi: 10.4251/wjgo.v17.i6.107919
Noninvasive prediction of Ki-67 expression in pancreatic cancer via contrast-enhanced ultrasound quantitative parameters: A diagnostic model study
Zi-Yi Yang, Wei-Na Wan, Lei Zhao, Si-Nong Li, Zhe Liu, Liang Sang
Zi-Yi Yang, Wei-Na Wan, Lei Zhao, Si-Nong Li, Liang Sang, Department of Ultrasonography, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
Zhe Liu, Department of Pancreatic-Biliary Surgery, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
Co-first authors: Zi-Yi Yang and Wei-Na Wan.
Co-corresponding authors: Zhe Liu and Liang Sang.
Author contributions: Yang ZY responsible for the writing of the paper; Yang ZY, Liu Z and Sang L participated in the conception and design of the study and were involved in the acquisition, analysis of data; Wan WN and Zhao L did contrast examination for the patients; Li SN responsible for statistical calculations on the data.
Supported by the Liaoning Province Science and Technology Plan Joint Program, No. 2024JH2/102600310.
Institutional review board statement: This study was supported by the Medical Science Research Ethics Committee of the First Affiliated Hospital of China Medical University (No. AF-SOP-07-1.2-01).
Informed consent statement: Informed consent was obtained from all patients.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
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: Liang Sang, MD, Doctor, Department of Ultrasonography, The First Affiliated Hospital of China Medical University, No. 155 Nanjing North Street, Heping District, Shenyang 110001, Liaoning Province, China. 20091213@cmu.edu.cn
Received: April 1, 2025
Revised: April 27, 2025
Accepted: May 21, 2025
Published online: June 15, 2025
Processing time: 73 Days and 5.3 Hours
Abstract
BACKGROUND

The expression level of Ki-67 and the degree of differentiation in pancreatic cancer determine tumor aggressiveness and patient prognosis, which holds significant implications for clinical decision-making. A major challenge in preoperative pancreatic ductal adenocarcinoma management is predicting tumor malignancy. Contrast-enhanced ultrasound (CEUS), a dynamic imaging technique based on blood pool visualization, can reveal lesion vasculature and provide quantitative perfusion data reflecting angiogenesis. By tracking contrast agent kinetics, CEUS offers non-invasive insights into tumor vascularization, helping assess malignancy potential.

AIM

To investigate the correlation between Ki-67 and pancreatic cancer differentiation using CEUS quantitative parameters and evaluated their diagnostic accuracy.

METHODS

This retrospective study analyzed pancreatic cancer patients who underwent CEUS and pathological confirmation. Pathological differentiation, clinical data, and quantitative CEUS parameters [maximum intensity (IMAX), rise time (RT), rise slope 50% (Rs50), rise slope 10%-90% (Rs1090), etc.] were collected. Based on Ki-67 expression (< 50% vs ≥ 50%), patients were divided into low- and high-expression groups. The study evaluated correlations between Ki-67 expression, differentiation degree, and CEUS quantitative parameters to assess tumor aggressiveness.

RESULTS

Among 54 patients (25 high Ki-67, 29 low Ki-67), significant differences (P < 0.05) were observed in Rs50, IMAX, wash-out area under the curve (WoutAUC), wash-in and out area under curve, and Rs1090 between high and low Ki-67 groups. High-expression patients showed elevated Rs50, IMAX, WoutAUC, and area under the curve (AUC), while RT and falling slope 50% (Fs50) were lower. Rs1090 demonstrated the highest diagnostic accuracy (AUC = 0.863, sensitivity = 0.92, specificity = 0.759). Fs50 was effective in low Ki-67 detection (AUC = 0.838). No correlation was found between enhancement patterns and Ki-67 or differentiation.

CONCLUSION

CEUS parameters (Rs50, IMAX, WoutAUC, Rs1090) strongly correlate with Ki-67, aiding non-invasive pancreatic cancer assessment. Rs1090/IMAX predict high Ki-67; Fs50 identifies low Ki-67, supporting CEUS for tumor aggressiveness evaluation.

Keywords: Contrast-enhanced ultrasound; Pancreatic cancer; Quantitative analysis; Ki-67 index; Pathological differentiation degree

Core Tip: This study systematically integrates contrast-enhanced ultrasound quantitative parameters with pathological markers (Ki-67 index and tumor grade) in pancreatic cancer for the first time. By combining ultrasonography, tumor pathology, and statistical methods, it provides a noninvasive approach to assess tumor proliferation and aggressiveness. The findings may enable more precise treatment decisions (e.g., surgery, chemotherapy, or targeted therapy), potentially improving clinical outcomes.