Comparison of semi-automatic and manual segmentation methods for tumor delineation on head and neck squamous cell carcinoma (HNSCC) positron emission tomography (PET) images.

Accurate and reproducible tumor delineation on Positron Emission Tomography (PET) images is required to validate predictive and prognostic models based on PET radiomic features. Manual segmentation of tumors is time-consuming whereas semi-automatic methods are easily implementable and inexpensive. This study assessed the reliability of semi-automatic segmentation methods over manual segmentation for tumor delineation in Head and Neck Squamous Cell Carcinoma (HNSCC) PET images.

Approach: We employed manual and six semi-automatic segmentation methods (Just Enough Interaction (JEI), watershed, grow from seeds (GfS), flood filling (FF), 30% SUVmax and 40%SUVmax threshold) using 3D slicer software to extract 128 radiomic features from FDG-PET images of 100 HNSCC patients independently by three operators. We assessed the distributional properties of all features and considered 92 log-transformed features for subsequent analysis. For each paired comparison of a feature, we fitted a separate linear mixed effect model using the method (two levels; manual method versus one semi-automatic method) as a fixed effect and the subject and the operator as the random effects. We estimated different statistics ¬- the intraclass correlation coefficient agreement (aICC), limits of agreement (LoA), total deviation index (TDI), coverage probability (CP) and coefficient of individual agreement (CIA) - to evaluate the agreement between the manual and semi-automatic methods.

Main Results: Accounting for all statistics across 92 features, the JEI method consistently demonstrated acceptable agreement with the manual method, with median values of aICC = 0.86, TDI = 0.94, CP = 0.66, and CIA = 0.91.

Significance: This study demonstrated that the JEI method is a reliable semi-automatic method for tumor delineation on HNSCC PET images.&#xD.