头颈部鳞状细胞癌的肿瘤体积定义——PET/MRI与组织病理学的比较

Tumor volume definitions in head and neck squamous cell carcinoma - Comparing PET/MRI and histopathology.

作者信息

Terzidis Emmanouil, Friborg Jeppe, Vogelius Ivan R, Lelkaitis Giedrius, von Buchwald Christian, Olin Anders B, Johannesen Helle H, Fischer Barbara M, Wessel Irene, Rasmussen Jacob H

机构信息

Department of Oncology, Section of Radiotherapy, Rigshospitalet, Copenhagen, Denmark; Department of Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.

Department of Oncology, Section of Radiotherapy, Rigshospitalet, Copenhagen, Denmark.

出版信息

Radiother Oncol. 2023 Mar;180:109484. doi: 10.1016/j.radonc.2023.109484. Epub 2023 Jan 20.

DOI:10.1016/j.radonc.2023.109484

PMID:36690303

Abstract

BACKGROUND AND PURPOSE

In cancer treatment precise definition of the tumor volume is essential, but despite development in imaging modalities, this remains a challenge. Here, pathological tumor volumes from the surgical specimens were obtained and compared to tumor volumes defined from modern PET/MRI hybrid imaging. The purpose is to evaluate mismatch between the volumes defined from imaging and pathology was estimated and potential clinical impact.

METHODS AND MATERIALS

Twenty-five patients with head and neck squamous cell carcinoma were scanned on an integrated PET/MRI system prior to surgery. Three gross tumor volumes (GTVs) from the primary tumor site were delineated defined from MRI (GTV), PET (GTV) and one by utilizing both anatomical images and clinical information (GTV). Twenty-five primary tumor specimens were extracted en bloc, scanned with PET/MRI and co-registered to the patient images. Each specimen was sectioned in blocks, sliced and stained with haematoxylin and eosin. All slices were digitalized and tumor delineated by a head and neck pathologist. The pathological tumor areas in all slices were interpolated yielding a pathological 3D tumor volume (GTV). GTVwas compared with the imaging GTV's and potential mismatch was estimated.

RESULTS

Thirteen patients were included. The mean volume of GTVwas larger than the GTV's defined from PET or MRI. The mean mismatch of the GTVcompared to the GTV, GTVand GTVwas 31.9 %, 54.5 % and 27.9 % respectively, and the entire GTV was only fully encompassed in GTV in 1 of 13 patients. However, after the addition of a clinical 5 mm margin the GTV was fully encompassed in GTV in 11 out of 13 patients.

CONCLUSIONS

Despite modern hybrid imaging modalities, a mismatch between imaging and pathological defined tumor volumes was observed in all patients.A 5 mm clinical margin was sufficient to ensure inclusion of the entire pathological volume in 11 out of 13 patients.

摘要

背景与目的

在癌症治疗中，精确界定肿瘤体积至关重要，但尽管成像技术有所发展，这仍是一项挑战。在此，获取了手术标本的病理肿瘤体积，并与通过现代PET/MRI混合成像界定的肿瘤体积进行比较。目的是评估成像界定体积与病理界定体积之间的不匹配情况及其潜在临床影响。

方法与材料

25例头颈部鳞状细胞癌患者在手术前接受了一体化PET/MRI系统扫描。从原发肿瘤部位界定出三个大体肿瘤体积（GTV），分别基于MRI（GTV）、PET（GTV）以及利用解剖图像和临床信息界定的一个GTV。整块提取25个原发肿瘤标本，用PET/MRI扫描并与患者图像进行配准。每个标本切成块，切片并用苏木精和伊红染色。所有切片数字化，由头颈病理学家界定肿瘤。对所有切片中的病理肿瘤区域进行插值，得出病理三维肿瘤体积（GTV）。将GTV与成像GTV进行比较，并评估潜在的不匹配情况。