Pre-operative estimation of esophageal tumor metabolic length in FDG-PET images with surgical pathology confirmation

Abstract

FDG-PET-derived tumor metabolic length of untreated esophageal carcinomas correlates well with surgical pathology results, and provides preliminary evidence that noninvasive delineation of the superior and inferior extent of viable tumor involvement might be feasible using computer-generated metabolic length measurements.

Impact of Manual and Automated Interpretation of Fused PET/CT Data on Esophageal Target Definitions in Radiation Planning

“…The semiautomated tumor segmentation technique employed a combination of tumor maximum intensity and liver intensity to define a lower tumor intensity threshold to define the extent of tumor. This method had been previously validated at our institution and produced good correlation between PET/CT length and pathologic length (19). The semiautomated segmentation produced major differences in 24% of patients compared with the manual PET/CT based target definition.…”

Comparison of Standardized Uptake Value–Based Positron Emission Tomography and Computed Tomography Target Volumes in Esophageal Cancer Patients Undergoing Radiotherapy

“…Because 95% of our patients had tumor invading the adventitia (Stage III) at the epicenter, and because CT, combined with information from the EUS, has been deemed quite accurate in determining the radial extent of the tumor, we believed this was an acceptable reference volume (3,4,6,7). Other studies have used pathologic tumor measurements as a reference comparison (19,21). This is not feasible in patients with locally advanced esophageal cancer, who typically undergo neoadjuvant or definitive concurrent chemoradiotherapy.…”

“…In the setting of non-small-cell lung cancer, Nestle et al (18) document a 3.6-fold difference in mean MTV, depending on the SUV-based thresholding mechanism used. Although none of the thresholding approaches have been standardized, the most common ones are broadly categorized as (1) absolute SUV (SUV Abs ), (2) SUV relative to the maximum tumor SUV (SUV % ), and (3) SUV relative to the mean liver SUV (SUV Ls ) (8,13,18,19). It is unclear which general category to use, and more importantly, what value to use within that category.…”

Prognostic significance of endoluminal ultrasound-defined disease length and tumor volume (EDTV) for patients with the diagnosis of esophageal cancer

“…In addition, PET can estimate metabolic disease volume, and currently is being assessed as a tool for planning treatment in esophageal cancer [33][34][35]. Tumor volumes calculated by means of CT-PET measurements would constitute a valuable comparison with EDTV related to prognosis, although CT-PET has limitations in that a proportion of tumors may be nonavid, resulting in an underestimate of the total volume [36].…”