PET-based delineation of tumour volumes in lung cancer: comparison with pathological findings

  • Andrea SchaeferEmail author
  • Yoo Jin Kim
  • Stephanie Kremp
  • Sebastian Mai
  • Jochen Fleckenstein
  • Hendrik Bohnenberger
  • Hans-Joachim Schäfers
  • Jan-Martin Kuhnigk
  • Rainer M. Bohle
  • Christian Rübe
  • Carl-Martin Kirsch
  • Aleksandar Grgic
Original Article



The objective of the study was to validate an adaptive, contrast-oriented thresholding algorithm (COA) for tumour delineation in 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) for non-small cell lung cancer (NSCLC) in comparison with pathological findings. The impact of tumour localization, tumour size and uptake heterogeneity on PET delineation results was also investigated.


PET tumour delineation by COA was compared with both CT delineation and pathological findings in 15 patients to investigate its validity. Correlations between anatomical volume, metabolic volume and the pathology reference as well as between the corresponding maximal diameters were determined. Differences between PET delineations and pathological results were investigated with respect to tumour localization and uptake heterogeneity.


The delineated volumes and maximal diameters measured on PET and CT images significantly correlated with the pathology reference (both r > 0.95, p < 0.0001). Both PET and CT contours resulted in overestimation of the pathological volume (PET 32.5 ± 26.5 %, CT 46.6 ± 27.4 %). CT volumes were larger than those delineated on PET images (CT 60.6 ± 86.3 ml, PET 48.3 ± 61.7 ml). Maximal tumour diameters were similar for PET and CT (51.4 ± 19.8 mm for CT versus 53.4 ± 19.1 mm for PET), slightly overestimating the pathological reference (mean difference CT 4.3 ± 3.2 mm, PET 6.2 ± 5.1 mm). PET volumes of lung tumours located in the lower lobe were significantly different from those determined from pathology (p = 0.037), whereas no significant differences were observed for tumours located in the upper lobe (p = 0.066). Only minor correlation was found between pathological tumour size and PET heterogeneity (r = −0.24).


PET tumour delineation by COA showed a good correlation with pathological findings. Tumour localization had an influence on PET delineation results. The impact of tracer uptake heterogeneity on PET delineation should be considered carefully and individually in each patient. Altogether, PET tumour delineation by COA for NSCLC patients is feasible and reliable with the potential for routine clinical application.


Volume delineation 18F-FDG PET Lung cancer Radiotherapy Pathology 



We gratefully acknowledge the valuable support of Dipl. Ing. P. Donsch in the preparation of the phantoms.

Conflicts of interest



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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Andrea Schaefer
    • 1
    Email author
  • Yoo Jin Kim
    • 2
  • Stephanie Kremp
    • 3
  • Sebastian Mai
    • 1
  • Jochen Fleckenstein
    • 3
  • Hendrik Bohnenberger
    • 1
  • Hans-Joachim Schäfers
    • 4
  • Jan-Martin Kuhnigk
    • 5
  • Rainer M. Bohle
    • 2
  • Christian Rübe
    • 3
  • Carl-Martin Kirsch
    • 1
  • Aleksandar Grgic
    • 1
  1. 1.Department of Nuclear MedicineSaarland University Medical CenterHomburgGermany
  2. 2.Department of PathologySaarland University Medical CenterHomburgGermany
  3. 3.Department of RadiooncologySaarland University Medical CenterHomburgGermany
  4. 4.Department of Thoracic and Cardiovascular SurgerySaarland University Medical CenterHomburgGermany
  5. 5.MeVis Research Center for Medical Diagnostic Systems and VisualizationBremenGermany

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