GLOW-FDG: Generalized cancer LesiOn Whole-body segmentation model for $^{18}$F-FDG-PET/CT

Maksym Fritsak, Maximilian Rokuss, Hubert S. Gabryś, Yannick Kirchhoff, Benjamin Hamm, Sebastian M. Christ, Nicolas Martz, Isabelle Opitz, Rolf Stahel, Martin Hüllner, Matthias Guckenberger, Klaus Maier-Hein, Stephanie Tanadini-Lang

Whole-body fluorodeoxyglucose positron emission tomography combined with computed tomography is widely used in cancer care, but manual lesion delineation is slow, subjective, and difficult to scale. We present GLOW-FDG, an open-source artificial intelligence model for whole-body cancer lesion segmentation in fluorodeoxyglucose positron emission tomography and computed tomography. The model was trained on 1,563 scans spanning multiple cancer types and evaluated on 185 external scans from independent institutions. Across breast cancer, nonmetastatic and oligometastatic lung cancer, head and neck cancer, and metastatic melanoma, GLOW-FDG consistently outperformed publicly available benchmark models in lesion detection, while reducing false positives and maintaining strong segmentation accuracy. Quantification of total tumor burden and total lesion glycolysis was robust across cohorts, and performance approached the variability observed between expert radiation oncologists. These results support GLOW-FDG as a generalizable tool for automated cancer segmentation and quantitative imaging biomarker extraction in whole-body imaging.