Objective: Accurate and reproducible tumor delineation on Positron Emission Tomography (PET) images is required to validate predictive and prognostic models based on PET radiomic features. Manual segmentation of tumors is time-consuming whereas semi-automatic methods are easily implementable and inexpensive. This study assessed the reliability of semi-automatic segmentation methods over manual segmentation for tumor delineation in Head and Neck Squamous Cell Carcinoma (HNSCC) PET images.

Approach: We employed manual and six semi-automatic segmentation methods (Just Enough Interaction (JEI), watershed, grow from seeds (GfS), flood filling (FF), 30% SUVmax and 40%SUVmax threshold) using 3D slicer software to extract 128 radiomic features from FDG-PET images of 100 HNSCC patients independently by three operators. We assessed the distributional properties of all features and considered 92 log-transformed features for subsequent analysis. For each paired comparison of a feature, we fitted a separate linear mixed effect model using the method (two levels; manual method versus one semi-automatic method) as a fixed effect and the subject and the operator as the random effects. We estimated different statistics ¬- the intraclass correlation coefficient agreement (aICC), limits of agreement (LoA), total deviation index (TDI), coverage probability (CP) and coefficient of individual agreement (CIA) - to evaluate the agreement between the manual and semi-automatic methods.

Main Results: Accounting for all statistics across 92 features, the JEI method consistently demonstrated acceptable agreement with the manual method, with median values of aICC = 0.86, TDI = 0.94, CP = 0.66, and CIA = 0.91.

Significance: This study demonstrated that the JEI method is a reliable semi-automatic method for tumor delineation on HNSCC PET images.