Delineation and agreement of FET PET biological volumes in glioblastoma: results of the nuclear medicine credentialing program from the prospective, multi-centre trial evaluating FET PET In Glioblastoma (FIG) study-TROG 18.06

Nathaniel Barry; Roslyn J Francis; Martin A Ebert; Eng-Siew Koh; Pejman Rowshanfarzad; Ghulam Mubashar Hassan; Jake Kendrick; Hui K Gan; Sze T Lee; Eddie Lau; Bradford A Moffat; Greg Fitt; Alisha Moore; Paul Thomas; David A Pattison; Tim Akhurst; Ramin Alipour; Elizabeth L Thomas; Edward Hsiao; Geoffrey P Schembri; Peter Lin; Tam Ly; June Yap; Ian Kirkwood; Wilson Vallat; Shahroz Khan; Dayanethee Krishna; Stanley Ngai; Chris Yu; Scott Beuzeville; Tow C Yeow; Dale Bailey; Olivia Cook; Angela Whitehead; Rachael Dykyj; Alana Rossi; Andrew Grose; Andrew M Scott

doi:10.1007/s00259-023-06371-5

Delineation and agreement of FET PET biological volumes in glioblastoma: results of the nuclear medicine credentialing program from the prospective, multi-centre trial evaluating FET PET In Glioblastoma (FIG) study-TROG 18.06

Eur J Nucl Med Mol Imaging. 2023 Nov;50(13):3970-3981. doi: 10.1007/s00259-023-06371-5. Epub 2023 Aug 11.

Authors

Nathaniel Barry^{1

2}, Roslyn J Francis^{3

4}, Martin A Ebert^{5

6

4

7}, Eng-Siew Koh^{8

9}, Pejman Rowshanfarzad^{5

6}, Ghulam Mubashar Hassan⁵, Jake Kendrick^{5

6}, Hui K Gan^{10

11

12

13}, Sze T Lee^{11

12

13

14}, Eddie Lau^{14

15

16}, Bradford A Moffat¹⁶, Greg Fitt¹⁵, Alisha Moore¹⁷, Paul Thomas^{18

19}, David A Pattison^{18

19}, Tim Akhurst^{12

20}, Ramin Alipour^{12

20}, Elizabeth L Thomas³, Edward Hsiao²¹, Geoffrey P Schembri²¹, Peter Lin^{9

22}, Tam Ly²², June Yap²², Ian Kirkwood^{23

24}, Wilson Vallat²³, Shahroz Khan²⁵, Dayanethee Krishna²⁵, Stanley Ngai²⁶, Chris Yu²⁶, Scott Beuzeville²⁷, Tow C Yeow²⁷, Dale Bailey^{21

28}, Olivia Cook¹⁷, Angela Whitehead¹⁷, Rachael Dykyj¹⁷, Alana Rossi¹⁷, Andrew Grose¹⁷, Andrew M Scott^{11

12

13

14}

Affiliations

¹ School of Physics, Mathematics and Computing, University of Western Australia, WA, Crawley, Australia. Nathaniel.barry@research.uwa.edu.au.
² Centre for Advanced Technologies in Cancer Research (CATCR), WA, Perth, Australia. Nathaniel.barry@research.uwa.edu.au.
³ Department of Nuclear Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.
⁴ Australian Centre for Quantitative Imaging, Medical School, University of Western Australia, Crawley, WA, Australia.
⁵ School of Physics, Mathematics and Computing, University of Western Australia, WA, Crawley, Australia.
⁶ Centre for Advanced Technologies in Cancer Research (CATCR), WA, Perth, Australia.
⁷ Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.
⁸ Department of Radiation Oncology, Liverpool and Macarthur Cancer Therapy Centres, Liverpool, NSW, Australia.
⁹ South Western Sydney Clinical School, UNSW Medicine, University of New South Wales, Liverpool, NSW, Australia.
¹⁰ Department of Medical Oncology, Austin Hospital, Melbourne, VIC, Australia.
¹¹ Olivia Newton-John Cancer Research Institute, Melbourne, VIC, Australia.
¹² Department of Medicine, University of Melbourne, Melbourne, VIC, Australia.
¹³ School of Cancer Medicine, La Trobe University, Melbourne, VIC, Australia.
¹⁴ Department of Molecular Imaging and Therapy, Austin Health, Melbourne, VIC, Australia.
¹⁵ Department of Radiology, Austin Health, Melbourne, VIC, Australia.
¹⁶ Department of Radiology, University of Melbourne, Melbourne, VIC, Australia.
¹⁷ Trans Tasman Radiation Oncology Group (TROG Cancer Research), University of Newcastle, Callaghan, NSW, Australia.
¹⁸ Department of Nuclear Medicine, Royal Brisbane and Women's Hospital, Herston, QLD, Australia.
¹⁹ Faculty of Medicine, University of Queensland, St Lucia, QLD, Australia.
²⁰ The Sir Peter MacCallum Department of Oncology, Melbourne, VIC, Australia.
²¹ Department of Nuclear Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia.
²² Department of Nuclear Medicine, Liverpool Hospital, Liverpool, NSW, Australia.
²³ Department of Nuclear Medicine, Royal Adelaide Hospital, Adelaide, SA, Australia.
²⁴ Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia.
²⁵ Department of Nuclear Medicine, Canberra Hospital, Woden, ACT, Australia.
²⁶ Department of Nuclear Medicine, Princess Alexandra Hospital, Woolloongabba, QLD, Australia.
²⁷ Department of Nuclear Medicine, St George Hospital, Kogarah, NSW, Australia.
²⁸ Faculty of Medicine 7 Health, University of Sydney, Sydney, NSW, Australia.

Abstract

Purpose: The O-(2-[¹⁸F]-fluoroethyl)-L-tyrosine (FET) PET in Glioblastoma (FIG) trial is an Australian prospective, multi-centre study evaluating FET PET for glioblastoma patient management. FET PET imaging timepoints are pre-chemoradiotherapy (FET1), 1-month post-chemoradiotherapy (FET2), and at suspected progression (FET3). Before participant recruitment, site nuclear medicine physicians (NMPs) underwent credentialing of FET PET delineation and image interpretation.

Methods: Sites were required to complete contouring and dynamic analysis by ≥ 2 NMPs on benchmarking cases (n = 6) assessing biological tumour volume (BTV) delineation (3 × FET1) and image interpretation (3 × FET3). Data was reviewed by experts and violations noted. BTV definition includes tumour-to-background ratio (TBR) threshold of 1.6 with crescent-shaped background contour in the contralateral normal brain. Recurrence/pseudoprogression interpretation (FET3) required assessment of maximum TBR (TBR_max), dynamic analysis (time activity curve [TAC] type, time to peak), and qualitative assessment. Intraclass correlation coefficient (ICC) assessed volume agreement, coefficient of variation (CoV) compared maximum/mean TBR (TBR_max/TBR_mean) across cases, and pairwise analysis assessed spatial (Dice similarity coefficient [DSC]) and boundary agreement (Hausdorff distance [HD], mean absolute surface distance [MASD]).

Results: Data was accrued from 21 NMPs (10 centres, n ≥ 2 each) and 20 underwent review. The initial pass rate was 93/119 (78.2%) and 27/30 requested resubmissions were completed. Violations were found in 25/72 (34.7%; 13/12 minor/major) of FET1 and 22/74 (29.7%; 14/8 minor/major) of FET3 reports. The primary reasons for resubmission were as follows: BTV over-contour (15/30, 50.0%), background placement (8/30, 26.7%), TAC classification (9/30, 30.0%), and image interpretation (7/30, 23.3%). CoV median and range for BTV, TBR_max, and TBR_mean were 21.53% (12.00-30.10%), 5.89% (5.01-6.68%), and 5.01% (3.37-6.34%), respectively. BTV agreement was moderate to excellent (ICC = 0.82; 95% CI, 0.63-0.97) with good spatial (DSC = 0.84 ± 0.09) and boundary (HD = 15.78 ± 8.30 mm; MASD = 1.47 ± 1.36 mm) agreement.

Conclusion: The FIG study credentialing program has increased expertise across study sites. TBR_max and TBR_mean were robust, with considerable variability in BTV delineation and image interpretation observed.

Keywords: Clinical trials; Credentialing; FET PET; Glioblastoma; Inter-observer.

Publication types

Multicenter Study

MeSH terms

Australia
Brain Neoplasms* / diagnostic imaging
Brain Neoplasms* / pathology
Ficus*
Glioblastoma* / diagnostic imaging
Glioblastoma* / pathology
Humans
Magnetic Resonance Imaging
Nuclear Medicine*
Positron-Emission Tomography / methods
Prospective Studies
Tyrosine

Substances

Tyrosine

Abstract

Publication types

MeSH terms

Substances

Grants and funding