The observed pattern indicates the emergence of a lactate-producing epithelial cell population in high %GP4 lesions, and this study has identified tissue-based biomarkers to detect this metabolic transformation such as tumour epithelial LDHA, LDHB, PDHA1, LDHA/PDHA1 ratio, and epithelium-to-stroma MCT4 ratio. Here, PDHA1 is linked to neoplasm.