FDG uptake heterogeneity in FIGO IIb cervical carcinoma does not predict pelvic lymph node involvement

Radiation Oncology

Perry W Grigsby²  Frank J Brooks¹ 

[1]Department of Radiation Oncology, Washington University School of Medicine, 4921 Parkview Place, Saint Louis, MO 63110, USA

[2]Alvin J Siteman Cancer Center, Washington University Medical Center, Saint Louis, MO, USA

关键词: Image texture analysis;    Intra-tumor heterogeneity;    FDG-PET;    Cervical cancer;   

Others  :  829413
DOI  :  10.1186/1748-717X-8-294

 received in 2013-09-25, accepted in 2013-12-13,  发布年份 2013

【 摘 要 】

Translational relevance

Many types of cancer are located and assessed via positron emission tomography (PET) using the 18F-fluorodeoxyglucose (FDG) radiotracer of glucose uptake. There is rapidly increasing interest in exploiting the intra-tumor heterogeneity observed in these FDG-PET images as an indicator of disease outcome. If this image heterogeneity is of genuine prognostic value, then it either correlates to known prognostic factors, such as tumor stage, or it indicates some as yet unknown tumor quality. Therefore, the first step in demonstrating the clinical usefulness of image heterogeneity is to explore the dependence of image heterogeneity metrics upon established prognostic indicators and other clinically interesting factors. If it is shown that image heterogeneity is merely a surrogate for other important tumor properties or variations in patient populations, then the theoretical value of quantified biological heterogeneity may not yet translate into the clinic given current imaging technology.

Purpose

We explore the relation between pelvic lymph node status at diagnosis and the visually evident uptake heterogeneity often observed in 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) images of cervical carcinomas.

Experimental design

We retrospectively studied the FDG-PET images of 47 node negative and 38 node positive patients, each having FIGO stage IIb tumors with squamous cell histology. Imaged tumors were segmented using 40% of the maximum tumor uptake as the tumor-defining threshold and then converted into sets of three-dimensional coordinates. We employed the sphericity, extent, Shannon entropy (S) and the accrued deviation from smoothest gradients (ζ) as image heterogeneity metrics. We analyze these metrics within tumor volume strata via: the Kolmogorov-Smirnov test, principal component analysis and contingency tables.

Results

We found no statistically significant difference between the positive and negative lymph node groups for any one metric or plausible combinations thereof. Additionally, we observed that S is strongly dependent upon tumor volume and that ζ moderately correlates with mean FDG uptake.

Conclusions

FDG uptake heterogeneity did not indicate patients with differing prognoses. Apparent heterogeneity differences between clinical groups may be an artifact arising from either the dependence of some image metrics upon other factors such as tumor volume or upon the underlying variations in the patient populations compared.

【 授权许可】

   
2013 Brooks and Grigsby; licensee BioMed Central Ltd.

【 图 表 】

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