title: Tumour volume delineation in prostate cancer assessed by [11C]choline PET/CT: validation with surgical specimens.
abstract: OBJECTIVE
  PET has been proven to be helpful in the delineation of gross tumour volume (GTV) for external radiation therapy in several tumour entities. The aim of this study was to determine if [(11)C]choline PET could be used to localize the carcinomatous tissue within the prostate in order to specifically target this area for example with high-precision radiation therapy.
  
  
  METHODS
  Included in this prospective study were 20 patients with histological proven prostate carcinoma who underwent [(11)C]choline PET/CT before radical prostatectomy. After surgical resection, specimens were fixed and cut into 5-mm step sections. In each section the area of the carcinoma was delineated manually by an experienced pathologist and digitalized, and the histopathological tumour volume was calculated. Shrinkage due to resection and fixation was corrected using in-vivo and ex-vivo CT data of the prostate. Histopathological tumour location and size were compared with the choline PET data. Different segmentation algorithms were applied to the PET data to segment the intraprostatic lesion volume.
  
  
  RESULTS
  A total of 28 carcinomatous lesions were identified on histopathology. Only 13 (46 %) of these lesions had corresponding focal choline uptake. In the remaining lesions, no PET uptake (2 lesions) or diffuse uptake not corresponding to the area of the carcinoma (13 lesions) was found. In the patients with corresponding PET lesions, no suitable SUV threshold (neither absolute nor relative) was found for GTV segmentation to fit the volume to the histological tumour volume.
  
  
  CONCLUSIONS
  The choline uptake pattern corresponded to the histological localization of prostate cancer in fewer than 50 % of lesions. Even when corresponding visual choline uptake was found, this uptake was highly variable between patients. Therefore SUV thresholding with standard algorithms did not lead to satisfying results with respect to defining tumour tissue in the prostate.
authors: Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany. Bundschuh_R@klinik.uni-wuerzburg.de
authors: Ralph A
authors: RA
authors: Bundschuh
authors: Christina M
authors: CM
authors: Wendl
authors: Gregor
authors: G
authors: Weirich
authors: Mathias
authors: M
authors: Eiber
authors: Michael
authors: M
authors: Souvatzoglou
authors: Uwe
authors: U
authors: Treiber
authors: Hubert
authors: H
authors: Kübler
authors: Tobias
authors: T
authors: Maurer
authors: Jürgen E
authors: JE
authors: Gschwend
authors: Hans
authors: H
authors: Geinitz
authors: Anca L
authors: AL
authors: Grosu
authors: Sibylle I
authors: SI
authors: Ziegler
authors: Bernd Joachim
authors: BJ
authors: Krause
mesh_terms: D000465:Algorithms; D002250:Carbon Radioisotopes / Q000494:pharmacology; D002277:Carcinoma / Q000175:diagnosis / Q000473:pathology; D002794:Choline / Q000494:pharmacology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D064847:Multimodal Imaging; D011446:Prospective Studies; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D019275:Radiopharmaceuticals / Q000494:pharmacology; D015203:Reproducibility of Results; D047368:Tumor Burden
chemical_list: D002250:Carbon Radioisotopes; D019275:Radiopharmaceuticals; D002794:Choline
references: Eur J Nucl Med Mol Imaging. 2007 Jan;34(1):45-53
references: 16932935
references: J Urol. 2006 Sep;176(3):954-60; discussion 960
references: 16890665
references: Clin Cancer Res. 2011 Jun 1;17(11):3751-9
references: 21493868
references: Strahlenther Onkol. 2012 Jul;188(7):592-8
references: 22441441
references: Radiat Oncol. 2012 Jan 30;7:14
references: 22289620
references: Urol Int. 2005;74(3):214-20
references: 15812206
references: Lancet. 2008 May 17;371(9625):1710-21
references: 18486743
references: J Nucl Med. 2004 Jan;45 Suppl 1:96S-101S
references: 14736840
references: Eur Urol. 2011 Dec;60(6):1133-9
references: 21889832
references: Urol Oncol. 2013 May;31(4):427-35
references: 21388835
references: Int J Radiat Oncol Biol Phys. 2008 Nov 15;72(4):972-9
references: 18954710
references: Am J Surg Pathol. 1996 Dec;20(12):1501-6
references: 8944043
references: Eur Urol. 2003 Jul;44(1):32-8; discussion 38-9
references: 12814672
references: Radiology. 2004 Oct;233(1):93-100
references: 15317953
references: Int J Radiat Oncol Biol Phys. 2005 Nov 15;63(4):1016-23
references: 15979817
references: J Urol. 2005 Jan;173(1):252-5
references: 15592091
references: Eur J Nucl Med. 2000 Sep;27(9):1415-9
references: 11007527
references: J Nucl Med. 2005 Oct;46(10):1642-9
references: 16204714
references: Eur J Nucl Med Mol Imaging. 2008 Jun;35(6):1065-73
references: 18200444
references: Int J Radiat Oncol Biol Phys. 2009 Mar 15;73(4):1135-40
references: 18786781
references: J Nucl Med. 2006 Feb;47(2):262-9
references: 16455632
references: Eur J Cancer. 2010 Jan;46(2):449-55
references: 19969447
references: Radiology. 2005 May;235(2):623-8
references: 15858102
references: J Nucl Med. 2006 Aug;47(8):1249-54
references: 16883001
references: Int J Radiat Oncol Biol Phys. 2008 Nov 15;72(4):1161-7
references: 18440729
references: Clin Nucl Med. 2008 Oct;33(10):671-6
references: 18806565
references: Eur J Nucl Med Mol Imaging. 2004 Mar;31(3):317-24
references: 14628097
references: Eur J Nucl Med Mol Imaging. 2005 Jul;32(7):742-8
references: 16052370
references: Eur Urol. 2008 Aug;54(2):392-401
references: 18456393
references: Eur Urol. 2002 Jul;42(1):18-23
references: 12121724
references: Strahlenther Onkol. 2010 Aug;186(8):423-9
references: 20803282
references: Eur J Nucl Med Mol Imaging. 2008 Feb;35(2):253-63
references: 17926036
references: Radiology. 2010 Mar;254(3):925-33
references: 20177103
references: Nuklearmedizin. 2006;45(3):126-33
references: 16710509
references: Cancer Treat Rev. 2006 Jun;32(4):245-60
references: 16563636
references: J Nucl Med. 2009 Oct;50(10):1585-93
references: 19759109
references: Int J Radiat Oncol Biol Phys. 2005 Jul 1;62(3):893-900
references: 15936575
references: J Magn Reson Imaging. 2010 May;31(5):1151-6
references: 20432351