Autocontouring and Manual Contouring: Which Is the Better Method for Target Delineation Using 18F-FDG PET/CT in Non-Small Cell Lung Cancer?

Previously, we showed that a CT window and level setting of 1,600 and -300 Hounsfield units, respectively, and autocontouring using an F-18-FDG PET 50% intensity level correlated best with pathologic results. The aim of this study was to compare this autocontouring with manual contouring, to determine which method is better. Methods: Seventeen patients with non-small cell lung cancer underwent F-18-FDG PET/CT before surgery. The maximum diameter on pathologic examination was determined. Seven sets of gross tumor volumes (GTVs) were defined. The first set (GTV(CT)) was contoured manually using only CT information. The second set (GTV(Auto)) was auto-contoured using a 50% intensity level for F-18-FDG PET images. The third set (GTV(Manual)) was manually contoured using a visual method on PET images. The other 4 sets combined CT and F-18-FDG PET images fused to one another to become composite volumes: GTV(CT+Auto), GTV(CT+Manual), GTV(CT+Auto), and GTV(CT-Manual). To quantitate the degree to which CT and F-18-FDG PET defined the same region of interest, a matching index was calculated for each case. The maximum diameter of GTV was compared with the maximum diameter on pathologic examination. Results: The median GTV(CT), GTV(Auto), GTV(Manual), GTV(CT+Auto), GTV(CT+Manual), GTV(CT-Auto), and GTV(CT-Manual) were 6.96, 2.42, 4.37, 7.46, 10.17, 2.21, and 3.38 cm(3), respectively. The median matching indexes of GTV(CT) versus GTV(CT+Auto), GTV(Auto) versus GTV(CT+Auto), GTV(CT) versus GTV(CT+Manual), and GTV(Manual) versus GTV(CT+Manual) were 0.86, 0.65, 0.88, and 0.81, respectively. Compared with the maximum diameter on pathologic examination, the correlations of GTV(CT), GTV(Auto), GTV(Manual), GTV(CT+Auto), and GTV(CT+Manual) were 0.87, 0.83, 0.93, 0.86, and 0.94, respectively. Conclusion: The matching index was higher for manual contouring than for autocontouring using a 50% intensity level on F-18-FDG PET images. When using a 50% intensity level to contour the target of non-small cell lung cancer, one should also consider using manual contouring of F-18-FDG PET to check for any missed disease.