Noninvasive prediction of Ki-67 expression in pancreatic cancer via contrast-enhanced ultrasound quantitative parameters: A diagnostic model study

doi:10.4251/wjgo.v17.i6.107919

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World Journal of Gastrointestinal Oncology

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastrointest Oncol. Jun 15, 2025; 17(6): 107919
Published online Jun 15, 2025. doi: 10.4251/wjgo.v17.i6.107919

Table 1 Baseline data of the two groups of patients, mean ± SD/n (%)

Characteristics	Ki-67 < 50%	Ki-67 ≥ 50%	P value
Age, year	59.93 ± 10.83	61.48 ± 7.90	0.642
Gender			0.816
Male	16 (29.6)	13 (24.1)
Female	13 (24.1)	12 (22.2)
CA19-9			0.746
Normal	8 (14.81)	6 (11.11)
Elevated	21 (38.89)	19 (35.19)
Diameter, cm	3.87 ± 1.39	4.84 ± 1.68	0.022^a
Location			0.259
Head	14 (25.93)	8 (14.81)
Neck	4 (7.41)	5 (9.26)
Body	5 (9.26)	9 (16.67)
Tail	6 (11.11)	3 (5.56)
Differentiation grade			0.301
Well	11 (20.37)	5 (9.26)
Moderately	7 (12.96)	6 (11.11)
Poorly	11 (20.37)	14 (25.92)
TNM stage			0.140
I	6	1
II	3	2
III	15	13
IV	4	9

^aP < 0.05.

CA: Carbohydrate antigen; TNM: Tumor node metastasis.

Table 2 Analysis of Ki-67 and degree of differentiation, n (%)

	Ki-67 < 50%	Ki-67 ≥ 50%	χ² value	P value
Well differentiated	11 (20.37)	5 (9.26)	2.404	0.301
Moderately differentiated	7 (12.96)	6 (11.11)
Poorly differentiated	11 (20.37)	14 (25.92)

P > 0.05.

Table 3 Contrast-enhanced ultrasound parameters in different Ki-67 expression groups, median (interquartile range)

	Ki-67 < 50%	Ki-67 ≥ 50%	U value	P value
Rs50	6.84 (5.23 to 10.55)	11.35 (9.56 to 15.10)	144.500	< 0.001^b
IMAX	46.37 (37.60 to 57.56)	74.12 (61.80 to 89.20)	102.000	< 0.001^b
RT	14.42 (10.97 to 15.30)	11.45 (9.35 to 12.32)	220.000	0.013^a
WinAUC	296.42 (162.34 to 550.78)	453.86 (178.36 to 1302.49)	278.000	0.143
FHT	32.58 (26.86 to 41.07)	30.70 (25.30 to 36.00)	311.500	0.376
WoutAUC	19911.74 (12434.98 to 27114.02)	30764.31 (22543.16 to 42157.32)	202.000	0.005^b
WioAUC	20609.49 (13213.08 to 27290.88)	31196.99 (22668.28 to 42665.07)	202.000	0.005^b
WoutR	19911.74 (195.31 to 354.02)	383.07 (331.66 to 696.14)	132.000	< 0.001^b
FT	73.82 (62.50 to 99.51)	71.36 (57.58 to 87.80)	305.000	0.319
Rs1090	4.57 (3.79 to 6.76)	10.47 (8.76 to 11.82)	99.000	< 0.001^b
WinR	25.33 (17.77 to 51.06)	37.99 (18.41 to 134.44)	275.500	0.131
Fs50	-0.52 (-0.68 to 0.38)	-0.92 (-1.16 to 0.76)	117.500	< 0.001^b
AUC	25841.89 (18120.31 to 37170.46)	39426.38 (31969.68 to 59121.85)	198.00	0.004^b
TTP	15.31 (11.28 to 17.36)	11.74 (10.30 to 13.10)	226.500	0.018^a
mTT	68.89 (54.54 to 91.66)	76.38 (48.34 to 94.23)	356.000	0.910

^aP < 0.05.

^bP < 0.01.

Rs50: Rise slope 50%; IMAX: Maximum intensity; RT: Rise time; WinAUC: Wash-in area under the curve; FHT: Falling half time; WoutAUC: Wash-out area under the curve; WioAUC: Wash-in and out area under curve; FT: Falling time; Rs1090: Rise slope 10%-90%; WinR: Wash-in rate; Fs50: Falling slope 50%; AUC: Area under the curve; TTP: Time to peak; mTT: Mean transit time; WoutR: Wash-out rate.

Table 4 Correlation of contrast-enhanced ultrasound parameters with different Ki-67 expression groups

	r value	P value
Rs50	0.538	< 0.001^b
IMAX	0.612	< 0.001^b
RT	-0.323	0.017^b
WinAUC	0.173	0.211
FHT	-0.174	0.209
WoutAUC	0.354	0.009^b
WioAUC	0.352	0.009^b
WoutR	0.517	< 0.001^b
FT	-0.156	0.260
Rs1090	0.618	< 0.001^b
WinR	0.212	0.125
Fs50	-0.577	< 0.001^b
AUC	0.373	0.006^b
TTP	-0.280	0.040^a
mTT	-0.087	0.532

^aP < 0.05.

^bP < 0.01.

Table 5 Comparison of contrast-enhanced ultrasound quantitative parameters across tumors with different differentiation degrees, median (interquartile range)

	Well differentiated	Moderately differentiated	Poorly differentiated	Z value	P value	r value	P’ value
mTT	57.7 (49.42 to 74.12)	77.88 (41.81 to 88.58)	78.40 (64.33 to 100.52)	6.037	0.049^a	-0.244	0.075
Rs50	9.31 (7.63 to 10.73)	10.59 (5.28 to 13.78)	10.30 (6.84 to 12.81)	0.367	0.832	-0.095	0.491
IMAX	54.30 (43.41 to 72.76)	54.37 (40.84 to 74.12)	58.56 (49.43 to 88.76)	0.687	0.709	-0.144	0.295
RT	12.34 (9.80 to 14.86)	12.67 (11.61 to 14.80)	11.84 (10.07 to 13.74)	0.687	0.709	0.084	0.084
WinAUC	408.93 (241.28 to 1082.16)	364.44 (155.50 to 850.82)	296.42 (158.84 to 557.33)	0.687	0.709	0.134	0.330
FHT	31.50 (24.84 to 35.99)	28.93 (26.85 to 41.07)	33.30 (26.25 to 38.29)	1.942	0.378	-0.135	0.329
WoutAUC	22454.57 (12938.39 to 29406.73)	25091.22 (14283.42 to 35206.22)	29167.97 (18501.77 to 42157.32)	0.687	0.709	-0.200	0.147
WioAUC	22967.65 (13223.69 to 29874.76)	25172.88 (15850.85 to 35361.72)	29454.95 (18687.11 to 42335.48)	0.687	0.709	-0.185	0.181
WoutR	300.37 (213.11 to 395.74)	326.56 (217.61 to 392.31)	353.32 (265.97 to 495.21)	0.687	0.709	-0.157	0.258
FT	68.60 (55.90 to 79.23)	67.97 (64.42 to 93.17)	75.15 (62.50 to 98.85)	2.077	0.353	-0.154	0.266
Rs1090	8.24 (4.33 to 8.76)	9.12 (4.14 to 11.45)	8.76 (5.85 to 10.83)	0.367	0.832	-0.189	0.172
WinR	36.73 (18.20 to 60.62)	29.80 (21.45 to 105.91)	25.33 (13.87 to 47.07)	2.077	0.353	0.157	0.258
Fs50	-0.75 (-1.10 to -0.48)	-0.75 (-1.00 to 0.50)	-0.67 (-0.93 to 0.56)	1.052	0.590	-0.028	0.841
AUC	32655.20 (17724.16 to 41094.57)	31111.52 (21612.44 to 43393.67)	38174.83 (25534.96 to 51066.60)	1.942	0.378	-0.166	0.229
TTP	13.39 (10.32 to 15.83)	13.70 (11.90 to 16.50)	12.37 (10.30 to 14.80)	0.709	0.378	0.125	0.367

^aP < 0.05.

P represents the P value of the median, and P’ represents the P value of the correlation analysis. mTT: Mean transit time; Rs50: Rise slope 50%; IMAX: Maximum intensity; RT: Rise time; WinAUC: Wash-in area under the curve; FHT: Falling half time; WoutAUC: Wash-out area under the curve; WioAUC: Wash-in and out area under curve; FT: Falling time; Rs1090: Rise slope 10%-90%; WinR: Wash-in rate; Fs50: Falling slope 50%; AUC: Area under the curve; TTP: Time to peak; WoutR: Wash-out rate.

Table 6 Analysis of the receiver operating characteristic curve for differentiating low expression of the Ki-67

	AUC (95%CI)	P value	Diagnostic threshold	Specificity	Sensitive	Youden
Rs50	0.199 (0.081-0.318)	0.000^b	28.09	1	0.034	0.034
IMAX	0.141 (0.036-0.246)	0.000^b	17.93	0	1	0
RT	0.697 (0.548-0.845)	0.013^b	13.305	0.92	0.586	0.506
WinAUC	0.383 (0.232-0.535)	0.143	247.535	0.36	0.655	0.015
FHT	0.570 (0.416-0.724)	0.376	44.05	0.92	0.241	0.161
WoutAUC	0.279 (0.141-0.416)	0.005^b	122023.5	1	0	0
WioAUC	0.279 (0.141-0.416)	0.005^b	128423.37	1	0	0
WoutR	0.380 (0.141-0.294)	0.000^b	1233.34	1	0	0
FT	0.579 (0.426-0.732)	0.319	90.095	0.84	0.345	0.185
Rs1090	0.137 (0.032-0.241)	0.000^b	23.195	1	0.034	0.034
WinR	0.380 (0.227-0.533)	0.131	75.55	0	1	0
Fs50	0.838 (0.726-0.949)	0.000^b	-0.695	0.88	0.759	0.639
AUC	0.273 (0.137-0.409)	0.004^b	164597.03	1	0	0
TTP	0.657 (0.502-0.812)	0.048^a	14.33	0.92	0.586	0.506
mTT	0.509 (0.352-0.666)	0.910	128.52	1	0.138	0.138
Size	0.138 (0.172-0.464)	0.022^a	0.70	1	0	0

^aP < 0.05.

^bP < 0.01.

CI: Confidence interval; Rs50: Rise slope 50%; IMAX: Maximum intensity; RT: Rise time; WinAUC: Wash-in area under the curve; FHT: Falling half time; WoutAUC: Wash-out area under the curve; WioAUC: Wash-in and out area under curve; FT: Falling time; Rs1090: Rise slope 10%-90%; WinR: Wash-in rate; Fs50: Falling slope 50%; AUC: Area under the curve; TTP: Time to peak; mTT: Mean transit time; WoutR: Wash-out rate.

Table 7 Analysis of the receiver operating characteristic curve for differentiating high expression of the Ki-67

	AUC (95%CI)	P value	Diagnostic threshold	Specificity	Sensitive	Youden
Rs50	0.801 (0.682-0.919)	0.000^b	7.105	0.586	1	0.586
IMAX	0.859 (0.754-0.964)	0.000^b	53.825	0.724	0.96	0.684
RT	0.303 (0.155-0.452)	0.013^b	7.31	0.103	0.96	0.063
WinAUC	0.617 (0.465-0.768)	0.143	1034.04	0.897	0.36	0.257
FHT	0.430 (0.276-0.584)	0.376	236.155	1	0.04	0.04
WoutAUC	0.721 (0.584-0.859)	0.005^b	29092.74	0.793	0.64	0.443
WioAUC	0.721 (0.584-0.859)	0.005^b	29327.415	0.793	0.64	0.433
WoutR	0.818 (0.706-0.930)	0.000^b	283.9	0.655	0.92	0.575
FT	0.421 (0.268-0.574)	0.319	67.805	0.414	0.6	0.014
Rs1090	0.863 (0.759-0.968)	0.000^b	6.958	0.759	0.92	0.679
WinR	0.620 (0.497-0.773)	0.131	72.18	0.897	0.36	0.257
Fs50	0.162 (0.051-0.274)	0.000^b	0.82	1	0	0
AUC	0.727 (0.591-0.863)	0.004^b	37672.645	0.759	0.65	0.399
TTP	0.343 (0.188-0.498)	0.048^a	8.84	0.241	0.88	0.121
mTT	0.491 (0.334-0.648)	0.910	66.745	0.483	0.64	0.123
Size	0.682 (0.536-0.828)	0.022^a	3.45	0.552	0.84	0.392

^aP < 0.05.

^bP < 0.01.

Table 8 Analysis of the correlation between enhancement modes and Ki-67 expression levels, n (%)

	Ki-67 < 50%	Ki-67 ≥ 50%	χ² value	P value
I	1 (3.45)	2 (8)	5.246	0.245
II	18 (62.07)	8 (32)
III	8 (27.59)	10 (40)
IV	2 (6.89)	1 (4)
V	0 (0)	0 (0)
VI	0 (0)	4 (16)

P > 0.05.

Table 9 Analysis of the correlation between enhancement modes and differentiation grade, n (%)

	Well differentiated	Moderately differentiated	Poorly differentiated	χ² value	P value
I	2 (12.5)	0 (0)	1 (4)	6.094	0.659
II	6 (37.5)	9 (69.23)	11 (44)
III	5 (31.25)	3 (23.08)	10 (40)
IV	0 (0)	0 (0)	1 (4)
V	0 (0)	0 (0)	0 (0)
VI	1 (6.25)	1 (7.69)	2 (8)

P > 0.05.

Citation: Yang ZY, Wan WN, Zhao L, Li SN, Liu Z, Sang L. Noninvasive prediction of Ki-67 expression in pancreatic cancer via contrast-enhanced ultrasound quantitative parameters: A diagnostic model study. World J Gastrointest Oncol 2025; 17(6): 107919
URL: https://www.wjgnet.com/1948-5204/full/v17/i6/107919.htm
DOI: https://dx.doi.org/10.4251/wjgo.v17.i6.107919