Constantinos Zamboglou1, Thomas F Fassbender2, Lina Steffan3, Florian Schiller4, Tobias Fechter5, Montserrat Carles5, Selina Kiefer6, Hans C Rischke3, Kathrin Reichel7, Nina-Sophie Schmidt-Hegemann8, Harun Ilhan9, Alin F Chirindel10, Guillaume Nicolas10, Christoph Henkenberens11, Thorsten Derlin12, Peter Bronsert6, Panayiotis Mavroidis13, Ronald C Chen13, Philipp T Meyer4, Juri Ruf4, Anca L Grosu3. 1. Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine. University of Freiburg, Germany; German Cancer Consortium (DKTK), Partner Site Freiburg, Germany; Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Germany. 2. Department of Nuclear Medicine, Medical Center - University of Freiburg, Faculty of Medicine. University of Freiburg, Germany. Electronic address: thomas.fassbender@uniklinik-freiburg.de. 3. Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine. University of Freiburg, Germany; German Cancer Consortium (DKTK), Partner Site Freiburg, Germany. 4. Department of Nuclear Medicine, Medical Center - University of Freiburg, Faculty of Medicine. University of Freiburg, Germany. 5. Division of Medical Physics, Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine. University of Freiburg, Germany. 6. Department of Pathology, Medical Center - University of Freiburg, Faculty of Medicine. University of Freiburg, Germany; German Cancer Consortium (DKTK), Partner Site Freiburg, Germany. 7. Department of Urology, Medical Center - University of Freiburg, Faculty of Medicine. University of Freiburg, Germany. 8. Department of Radiation Oncology, University Hospital, LMU Munich, Germany. 9. Department of Nuclear Medicine, University Hospital, LMU Munich, Germany. 10. Department of Radiology and Nuclear Medicine, University Hospital Basel, Switzerland. 11. Department of Radiation Oncology, Hannover Medical School, Germany. 12. Department of Nuclear Medicine, Hannover Medical School, Germany. 13. Department of Radiation Oncology, University North Carolina - Chapel Hill, USA.
Abstract
PURPOSE: Accurate definition of the intraprostatic gross tumor volume (GTV) is crucial for diagnostic and therapeutic approaches in patients with primary prostate cancer (PCa). The optimal methodology for contouring of GTV using Prostate specific membrane antigen positron emission tomography (PSMA-PET) information has not yet been defined. METHODS AND MATERIALS: PCa patients who underwent a [68Ga]PSMA-11-PET/CT followed by radical prostatectomy were prospectively enrolled (n = 20). Six observer teams with different levels of experience and using different PET image scaling techniques performed manual contouring of GTV. Additionally, semi-automatic segmentation of GTVs was performed using SUVmax thresholds of 20-50%. Coregistered histopathological gross tumor volume (GTV-Histo) served as reference. Inter-observer agreement was assessed by calculating the Dice similarity coefficient (DSC). RESULTS: Most contouring methods provided high sensitivity and specificity. For manual delineation, scaling the PET images from SUVmin-max: 0-5 resulted in high sensitivity (>86%). The highest specificity (100%) was obtained by scaling the PET images from SUVmin-max: 0-SUVmax. High interobserver agreement (median DSC 0.8) was observed when using the same PET image scaling technique (PET images SUVmin-max: 0-5). For semi-automatic segmentation, a low SUVmax threshold of 20% optimized sensitivity (SUVmax threshold 20%, 100% sensitivity, 32% of prostatic volume), whereas a higher threshold optimized specificity (SUVmax threshold 40%-50%, 100% specificity). CONCLUSIONS: Contouring of regions with high tracer-uptake resulted in very high specificities and should be used for biopsy guidance. Both manual and semi-automatic approaches using validated SUV scaling (SUVmin-max: 0-5) or thresholding (20%) may provide high sensitivity, and should be considered for PSMA-PET-based focal therapy approaches.
PURPOSE: Accurate definition of the intraprostatic gross tumor volume (GTV) is crucial for diagnostic and therapeutic approaches in patients with primary prostate cancer (PCa). The optimal methodology for contouring of GTV using Prostate specific membrane antigen positron emission tomography (PSMA-PET) information has not yet been defined. METHODS AND MATERIALS: PCa patients who underwent a [68Ga]PSMA-11-PET/CT followed by radical prostatectomy were prospectively enrolled (n = 20). Six observer teams with different levels of experience and using different PET image scaling techniques performed manual contouring of GTV. Additionally, semi-automatic segmentation of GTVs was performed using SUVmax thresholds of 20-50%. Coregistered histopathological gross tumor volume (GTV-Histo) served as reference. Inter-observer agreement was assessed by calculating the Dice similarity coefficient (DSC). RESULTS: Most contouring methods provided high sensitivity and specificity. For manual delineation, scaling the PET images from SUVmin-max: 0-5 resulted in high sensitivity (>86%). The highest specificity (100%) was obtained by scaling the PET images from SUVmin-max: 0-SUVmax. High interobserver agreement (median DSC 0.8) was observed when using the same PET image scaling technique (PET images SUVmin-max: 0-5). For semi-automatic segmentation, a low SUVmax threshold of 20% optimized sensitivity (SUVmax threshold 20%, 100% sensitivity, 32% of prostatic volume), whereas a higher threshold optimized specificity (SUVmax threshold 40%-50%, 100% specificity). CONCLUSIONS: Contouring of regions with high tracer-uptake resulted in very high specificities and should be used for biopsy guidance. Both manual and semi-automatic approaches using validated SUV scaling (SUVmin-max: 0-5) or thresholding (20%) may provide high sensitivity, and should be considered for PSMA-PET-based focal therapy approaches.
Authors: Cédric Draulans; Robin De Roover; Uulke A van der Heide; Linda Kerkmeijer; Robert J Smeenk; Floris Pos; Wouter V Vogel; James Nagarajah; Marcel Janssen; Sofie Isebaert; Frederik Maes; Cindy Mai; Raymond Oyen; Steven Joniau; Martina Kunze-Busch; Karolien Goffin; Karin Haustermans Journal: Eur J Nucl Med Mol Imaging Date: 2020-10-06 Impact factor: 9.236
Authors: Simon K B Spohn; Viktoria Birkenmaier; Juri Ruf; Michael Mix; August Sigle; Erik Haehl; Sonja Adebahr; Tanja Sprave; Eleni Gkika; Alexander Rühle; Nils H Nicolay; Simon Kirste; Anca L Grosu; Constantinos Zamboglou Journal: Front Oncol Date: 2022-06-07 Impact factor: 5.738
Authors: M Unterrainer; C Eze; H Ilhan; S Marschner; O Roengvoraphoj; N S Schmidt-Hegemann; F Walter; W G Kunz; P Munck Af Rosenschöld; R Jeraj; N L Albert; A L Grosu; M Niyazi; P Bartenstein; C Belka Journal: Radiat Oncol Date: 2020-04-21 Impact factor: 3.481
Authors: Simon Spohn; Chiara Jaegle; Thomas F Fassbender; Tanja Sprave; Eleni Gkika; Nils H Nicolay; Michael Bock; Juri Ruf; Matthias Benndorf; Christian Gratzke; Anca L Grosu; Constantinos Zamboglou Journal: Eur J Nucl Med Mol Imaging Date: 2020-04-28 Impact factor: 9.236
Authors: Hans Theodor Eich; Kambiz Rahbar; Sergiu Scobioala; Christopher Kittel; Heidi Wolters; Sebastian Huss; Khaled Elsayad; Robert Seifert; Lars Stegger; Matthias Weckesser; Uwe Haverkamp Journal: Ann Nucl Med Date: 2021-03-19 Impact factor: 2.668
Authors: Constantinos Zamboglou; Maria Kramer; Selina Kiefer; Peter Bronsert; Lara Ceci; August Sigle; Wolfgang Schultze-Seemann; Cordula A Jilg; Tanja Sprave; Thomas F Fassbender; Nils H Nicolay; Juri Ruf; Matthias Benndorf; Anca L Grosu; Simon K B Spohn Journal: Sci Rep Date: 2021-03-12 Impact factor: 4.379
Authors: Maria Kramer; Simon K B Spohn; Selina Kiefer; Lara Ceci; August Sigle; Benedict Oerther; Wolfgang Schultze-Seemann; Christian Gratzke; Michael Bock; Fabian Bamberg; Anca L Grosu; Matthias Benndorf; Constantinos Zamboglou Journal: Front Oncol Date: 2020-11-23 Impact factor: 6.244
Authors: Constantin Lapa; Ursula Nestle; Nathalie L Albert; Christian Baues; Ambros Beer; Andreas Buck; Volker Budach; Rebecca Bütof; Stephanie E Combs; Thorsten Derlin; Matthias Eiber; Wolfgang P Fendler; Christian Furth; Cihan Gani; Eleni Gkika; Anca-L Grosu; Christoph Henkenberens; Harun Ilhan; Steffen Löck; Simone Marnitz-Schulze; Matthias Miederer; Michael Mix; Nils H Nicolay; Maximilian Niyazi; Christoph Pöttgen; Claus M Rödel; Imke Schatka; Sarah M Schwarzenboeck; Andrei S Todica; Wolfgang Weber; Simone Wegen; Thomas Wiegel; Constantinos Zamboglou; Daniel Zips; Klaus Zöphel; Sebastian Zschaeck; Daniela Thorwarth; Esther G C Troost Journal: Strahlenther Onkol Date: 2021-07-14 Impact factor: 3.621
Authors: Dejan Kostyszyn; Tobias Fechter; Nico Bartl; Anca L Grosu; Christian Gratzke; August Sigle; Michael Mix; Juri Ruf; Thomas F Fassbender; Selina Kiefer; Alisa S Bettermann; Nils H Nicolay; Simon Spohn; Maria U Kramer; Peter Bronsert; Hongqian Guo; Xuefeng Qiu; Feng Wang; Christoph Henkenberens; Rudolf A Werner; Dimos Baltas; Philipp T Meyer; Thorsten Derlin; Mengxia Chen; Constantinos Zamboglou Journal: J Nucl Med Date: 2020-10-30 Impact factor: 10.057