Accuracy of gross tumour volume delineation with [68Ga]-PSMA-PET compared to histopathology for high-risk prostate cancer

Authors

  • Maryam Zarei Department of Diagnostics and Intervention, Biomedical engineering and Radiation Physics, Umeå University, Umeå, Sweden https://orcid.org/0000-0002-3955-3329
  • Elin Wallsten Department of Diagnostics and Intervention, Biomedical engineering and Radiation Physics, Umeå University, Umeå, Sweden
  • Josefine Grefve Department of Diagnostics and Intervention, Biomedical engineering and Radiation Physics, Umeå University, Umeå, Sweden
  • Karin Söderkvist Department of Diagnostics and Intervention, Oncology, Umeå University, Umeå, Sweden
  • Adalsteinn Gunnlaugsson Skane University Hospital, Department of Hematology, Oncology and Radiation Physics, Lund, Sweden
  • Kristina Sandgren Department of Diagnostics and Intervention, Biomedical engineering and Radiation Physics, Umeå University, Umeå, Sweden
  • Joakim Jonsson Department of Diagnostics and Intervention, Biomedical engineering and Radiation Physics, Umeå University, Umeå, Sweden
  • Angsana Keeratijarut Lindberg Department of Diagnostics and Intervention, Biomedical engineering and Radiation Physics, Umeå University, Umeå, Sweden
  • Erik Nilsson Department of Diagnostics and Intervention, Biomedical engineering and Radiation Physics, Umeå University, Umeå, Sweden
  • Anders Bergh Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden
  • Björn Zackrisson Department of Diagnostics and Intervention, Oncology, Umeå University, Umeå, Sweden
  • Mathieu Moreau Skane University Hospital, Department of Hematology, Oncology and Radiation Physics, Lund, Sweden
  • Camilla Thellenberg Karlsson Department of Diagnostics and Intervention, Oncology, Umeå University, Umeå, Sweden
  • Lars E. Olsson Department of Translational Medicine, Medical Radiation Physics, Lund University, Malmö, Sweden
  • Anders Widmark Department of Diagnostics and Intervention, Oncology, Umeå University, Umeå, Sweden
  • Katrine Riklund Department of Diagnostics and Intervention, Diagnostic Radiology, Umeå University, Umeå, Sweden
  • Lennart Blomqvist Department of Diagnostics and Intervention, Biomedical engineering and Radiation Physics, Umeå University, Umeå, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna, Sweden
  • Vibeke Berg Loegager Department of Radiology, Copenhagen University Hospital in Herlev, Herlev, Denmark
  • Jan Axelsson Department of Diagnostics and Intervention, Biomedical engineering and Radiation Physics, Umeå University, Umeå, Sweden
  • Sara N. Strandberg Department of Diagnostics and Intervention, Diagnostic Radiology, Umeå University, Umeå, Sweden
  • Tufve Nyholm Department of Diagnostics and Intervention, Biomedical engineering and Radiation Physics, Umeå University, Umeå, Sweden

DOI:

https://doi.org/10.2340/1651-226X.2024.39041

Keywords:

Prostate cancer, PSMA-PET, Histopathology, semi-automatic segmentation

Abstract

Background: The delineation of intraprostatic lesions is vital for correct delivery of focal radiotherapy boost in patients with prostate cancer (PC). Errors in the delineation could translate into reduced tumour control and potentially increase the side effects. The purpose of this study is to compare PET-based delineation methods with histopathology.

Materials and methods: The study population consisted of 15 patients with confirmed high-risk PC intended for prostatectomy. [68Ga]-PSMA-PET/MR was performed prior to surgery. Prostate lesions identified in histopathology were transferred to the in vivo [68Ga]-PSMA-PET/MR coordinate system. Four radiation oncologists manually delineated intraprostatic lesions based on PET data. Various semi-automatic segmentation methods were employed, including absolute and relative thresholds, adaptive threshold, and multi-level Otsu threshold.

Results: The gross tumour volumes (GTVs) delineated by the oncologists showed a moderate level of interobserver agreement with Dice similarity coefficient (DSC) of 0.68. In comparison with histopathology, manual delineations exhibited the highest median DSC and the lowest false discovery rate (FDR) among all approaches. Among semi-automatic approaches, GTVs generated using standardized uptake value (SUV) thresholds above 4 (SUV > 4) demonstrated the highest median DSC (0.41), with 0.51 median lesion coverage ratio, FDR of 0.66 and the 95th percentile of the Hausdorff distance (HD95%) of 8.22 mm.

Interpretation: Manual delineations showed a moderate level of interobserver agreement. Compared to histopathology, manual delineations and SUV > 4 exhibited the highest DSC and the lowest HD95% values. The methods that resulted in a high lesion coverage were associated with a large overestimation of the size of the lesions.

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2024-06-23

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Zarei, M., Wallsten, E. ., Grefve, J. ., Söderkvist, K., Gunnlaugsson, A. ., Sandgren, K., … Nyholm, T. (2024). Accuracy of gross tumour volume delineation with [68Ga]-PSMA-PET compared to histopathology for high-risk prostate cancer. Acta Oncologica, 63(1), 503–510. https://doi.org/10.2340/1651-226X.2024.39041

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Vol. 63 (2024): Acta Oncologica

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Copyright (c) 2023 Maryam Zarei, Elin Wallsten, Josefine Grefve, Karin Söderkvist, Adalsteinn Gunnlaugsson, Kristina Sandgren, Joakim Jonsson, Angsana Keeratijarut Lindberg, Erik Nilsson, Anders Bergh, Björn Zackrisson, Mathieu Moreau, Camilla Thellenberg Karlsson, Lars E. Olsson, Anders Widmark, Katrine Riklund, Lennart Blomqvist, Vibeke Berg Loegager, Jan Axelsson, Sara N. Strandberg, Tufve Nyholm

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