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GTV spatial conformity between different delineation methods by FDG PET/CT and pathology in esophageal cancer
Authors:Wen Yu  Ying-Jian Zhang  Lei Shen  Joe Y. Chang
Affiliation:a Department of Radiation Oncology, Cancer Hospital, Fudan University, Shanghai, China
b Department of Nuclear Medicine, Cancer Hospital, Fudan University, Shanghai, China
c Department of Thoracic Surgery, Cancer Hospital, Fudan University, Shanghai, China
d Department of Pathology, Cancer Hospital, Fudan University, Shanghai, China
e Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Abstract:

Purpose

To find optimal threshold of length and GTV delineation for esophageal cancer using 18FDG PET/CT.

Materials and methods

Sixteen patients with esophageal carcinoma underwent surgery. For each patient, six GTVs were defined. GTVCT was based on CT data alone. GTV20%, GTV40%, GTV2.5 and GTV40%M were generated by PET/CT, using SUVbgd + 20%(SUVmax(slice) − SUVbgd), SUVbgd + 40%(SUVmax(slice) − SUVbgd), 2.5 and 40%SUVmax(total) as thresholds. GTVpath was derived from pathology. Lengths of GTVs were recorded as LCT, L20%, L40%, L2.5,L40%M and Lpath, respectively. The former five GTVs/lengths were compared with GTVpath/Lpath by means of a conformity index CI/CI′, which is the square of intersection of two GTVs/lengths divided by their product.

Results

Mean LCT, L20%, L40%, L2.5, L40%M and Lpath were 6.30 ± 2.69, 5.55 ± 2.48, 6.80 ± 2.92, 6.65 ± 2.66, 4.88 ± 1.99 and 5.90 ± 2.38 cm. Mean View the MathML source, View the MathML source, View the MathML source, View the MathML source and View the MathML source were 0.68 ± 0.16, 0.84 ± 0.17, 0.76 ± 0.14, 0.78 ± 0.15 and 0.80 ± 0.11. View the MathML source and View the MathML source was significantly superior to View the MathML source (P < 0.05). Mean GTVCT, GTV20%, GTV40%, GTV2.5, GTV40%M and GTVpath were 29.16 ± 18.56, 18.75 ± 12.37, 12.52 ± 8.08, 22.69 ± 14.84, 9.18 ± 5.96 and 28.16 ± 17.02 cm3. Mean CIs increased significantly from CI40%&path(0.27 ± 0.09) and CI40%M&path(0.28 ± 0.08) < CI20%&path(0.52 ± 0.16) and CI2.5&path(0.52 ± 0.20) < CICT&path(0.77 ± 0.17).

Conclusions

The SUVbgd + 20%(SUVmax(slice) − SUVbgd) method optimally estimated gross tumor length, but only reached an unsatisfactory CI for GTV. Due to possible motion factor enveloped in PET images and lack of histopathologic transverse reference, the information from both PET and CT should be referred to complementarily when delineating GTV.
Keywords:Fluorodeoxyglucose (FDG)   Positron emission tomography/computer tomography (PET/CT)   Esophageal carcinoma   Optimal threshold   Target volume delineation
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