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

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Abstract

Objective

The aim of this study was to evaluate a 3D tumor segmentation method for fluorodeoxyglucose positron emission tomography (FDG-PET) in the context of noninvasive estimation of tumor metabolic length (L m), as it correlates with surgical pathology and phantom results.

Methods

Thirty-four patients (7 women, 27 men) with esophageal cancer were retrospectively evaluated. All patients underwent FDG-PET-computed tomography (CT) imaging following endoscopic ultrasound (EUS). Seventeen patients had esophagectomy after PET/CT, without prior neoadjuvant therapy. Tumor length was assessed by EUS (L e, n = 31) and histopathology (L p, n = 17). Images were evaluated quantitatively with a 3D threshold-based region-growing program (Medical Image Processing Analysis and Visualization). L m, total metabolic volume (V m), maximum standardized uptake value (SUVmax), and average SUV (SUVa) over the entire tumor were obtained for several threshold values (mean activity in the liver plus 0-, 1-, 2-, 3-, and 4-SD of the activity in the liver).

Results

L m showed a good correlation with L p for all thresholds (best correlation for L m(2-SD), r = 0.74, P < 0.001). A positive nonsignificant correlation was observed between L p and L e (r = 0.30, P = 0.29). L m(2-SD) correlated well with L e (r = 0.71, P < 0.001). Good correlations were also observed between L m(2-SD) and V m(2-SD) (r = 0.89, P < 0.001) and SUVa(2-SD) (r = 0.38, P < 0.05). V m(2-SD) also had a significant correlation with L p (r = 0.61, P < 0.05) and L e (r = 0.57, P < 0.001).

Conclusions

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.

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Authors and Affiliations

  1. Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA

    Marcelo Mamede, Georges El Fakhri & Victor H. Gerbaudo

  2. Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA

    Paula Abreu-e-Lima & Vânia Nosé

  3. Biomedical Imaging Research Services Section, Center for Technology Information, National Institutes of Health (NIH), Bethesda, MD, USA

    William Gandler

Authors
  1. Marcelo Mamede
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  2. Georges El Fakhri
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  3. Paula Abreu-e-Lima
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  4. William Gandler
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  5. Vânia Nosé
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  6. Victor H. Gerbaudo
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Correspondence to Victor H. Gerbaudo.

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Mamede, M., Fakhri, G., Abreu-e-Lima, P. et al. Pre-operative estimation of esophageal tumor metabolic length in FDG-PET images with surgical pathology confirmation. Ann Nucl Med 21, 553–562 (2007). https://doi.org/10.1007/s12149-007-0040-0

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  • DOI: https://doi.org/10.1007/s12149-007-0040-0

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