Emerging non-invasive imaging biomarkers of Ki-67 in pancreatic cancer: Toward predictive precision oncology

The proliferative index of Ki-67 in pancreatic ductal adenocarcinoma (PDAC) exhibits strong correlations with tumor progression and prognosis, holding significant clinical implications. Yang <i>et al</i> 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 <i>via</i> 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 <i>et al</i> 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.