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"documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Med Clin. 2018;151:103-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 17 "formatos" => array:2 [ "HTML" => 7 "PDF" => 10 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original</span>" "titulo" => "Tasas de incidencia de ingresos asociados a síndrome de abstinencia alcohólica en España: análisis del conjunto mínimo básico de datos 1999-2010" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "103" "paginaFinal" => "108" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Incidence rates of admissions associated with alcohol withdrawal syndrome in Spain: Analysis of minimum basic data set 1999-2010" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1319 "Ancho" => 2059 "Tamanyo" => 197690 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Evolución de la tasa de ingresos por 100.000 habitantes asociados a síndrome de abstinencia alcohólica en España en el periodo 1999-2010, estratificados por grupos de edad.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Raquel Gómez-Méndez, Rafael Monte-Secades, Pablo Ventura-Valcárcel, Ramón Rabuñal-Rey, Héctor Guerrero-Sande, Antonio J. Chamorro-Fernández, Sonia Pértega-Díaz" "autores" => array:8 [ 0 => array:2 [ "nombre" => "Raquel" "apellidos" => "Gómez-Méndez" ] 1 => array:2 [ "nombre" => "Rafael" "apellidos" => "Monte-Secades" ] 2 => array:2 [ "nombre" => "Pablo" "apellidos" => "Ventura-Valcárcel" ] 3 => array:2 [ "nombre" => "Ramón" "apellidos" => "Rabuñal-Rey" ] 4 => array:2 [ "nombre" => "Héctor" "apellidos" => "Guerrero-Sande" ] 5 => array:2 [ "nombre" => "Antonio J." 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"documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Med Clin. 2018;151:89-96" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 16 "formatos" => array:2 [ "HTML" => 8 "PDF" => 8 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original</span>" "titulo" => "Evaluación del nódulo tiroideo con ecografía y elastografía de alta resolución sin la punción-aspiración con aguja fina" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "89" "paginaFinal" => "96" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Evaluation of the thyroid nodule with high-resolution ultrasonography and elastography without fine needle aspiration biopsy" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1562 "Ancho" => 2500 "Tamanyo" => 274391 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Patrones de clasificación de la elastografía tiroidea.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Antonio Ríos, José Manuel Rodríguez, Nuria María Torregrosa, Begoña Torregrosa, Angela Cepero, María Dolores Abellán, Antonio Miguel Hernández, Pascual Parrilla" "autores" => array:8 [ 0 => array:2 [ "nombre" => "Antonio" "apellidos" => "Ríos" ] 1 => array:2 [ "nombre" => "José Manuel" "apellidos" => "Rodríguez" ] 2 => array:2 [ "nombre" => "Nuria María" "apellidos" => "Torregrosa" ] 3 => array:2 [ "nombre" => "Begoña" "apellidos" => "Torregrosa" ] 4 => array:2 [ "nombre" => "Angela" "apellidos" => "Cepero" ] 5 => array:2 [ "nombre" => "María Dolores" "apellidos" => "Abellán" ] 6 => array:2 [ "nombre" => "Antonio Miguel" "apellidos" => "Hernández" ] 7 => array:2 [ "nombre" => "Pascual" "apellidos" => "Parrilla" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2387020618302316" "doi" => "10.1016/j.medcle.2018.05.029" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020618302316?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775317307534?idApp=UINPBA00004N" "url" => "/00257753/0000015100000003/v2_201807210407/S0025775317307534/v2_201807210407/es/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Usefulness of CA125 and its kinetic parameters and positron emission tomography/computed tomography (PET/CT) with fluorodeoxyglucose ([<span class="elsevierStyleSup">18</span>F] FDG) in the detection of recurrent ovarian cancer" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "97" "paginaFinal" => "102" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Azahara Palomar Muñoz, José Manuel Cordero García, Prado Talavera Rubio, Ana M. García Vicente, Beatriz González García, María Emiliana Bellón Guardia, Ángel Soriano Castrejón, Enrique Aranda Aguilar" "autores" => array:8 [ 0 => array:4 [ "nombre" => "Azahara" "apellidos" => "Palomar Muñoz" "email" => array:1 [ 0 => "azapalomar@gmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "José Manuel" "apellidos" => "Cordero García" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 2 => array:3 [ "nombre" => "Prado" "apellidos" => "Talavera Rubio" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Ana M." "apellidos" => "García Vicente" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Beatriz" "apellidos" => "González García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "María Emiliana" "apellidos" => "Bellón Guardia" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 6 => array:3 [ "nombre" => "Ángel" "apellidos" => "Soriano Castrejón" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 7 => array:3 [ "nombre" => "Enrique" "apellidos" => "Aranda Aguilar" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Nuclear, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Medicina Nuclear, Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Medicina Nuclear, Hospital Universitario La Paz, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Oncología Médica, Hospital Universitario Reina Sofía, Córdoba, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Utilidad del CA125 y sus parámetros cinéticos y de la tomografía por emisión de positrones/tomografía computarizada (PET/TC) con fluorodesoxiglucosa ([<span class="elsevierStyleSup">18</span>F]FDG) en la detección de la recidiva del cáncer de ovario" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 2483 "Ancho" => 2524 "Tamanyo" => 237225 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Comparison of CA125 (A), CA125dt (B), CA125vel (C) and SUVmax (D) in both groups, with tumour marker within normal and above the reference normal limit, based on final diagnosis.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Ovarian cancer is the main cause of death from gynaecologic malignancies. This poor survival rate is attributed to frequent persistence or recurrence of disease, with an overall recurrence rate of approximately 70% in the first 3 years.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">1</span></a> However, recurrence varies from 10% for stage I to 85% for stage IV with suboptimal debulking.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">2</span></a> After completion of adjuvant chemotherapy, a systematic follow up is needed. The epithelial marker cancer antigen 125 (CA125) has routinely been used for monitoring ovarian cancer patients who have reached a clinical complete remission on first-line debulking and chemotherapy. Regular measurements during follow up can detect recurrence of cancer months before symptoms or signs occur.<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">3,4</span></a> Nevertheless, there is no evidence of a survival benefit with early treatment of relapse based on a raised CA125 concentration alone.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">5</span></a> Therefore, it is crucial to discriminate between relapse of ovarian cancer and benign increases in patients with ovarian cancer and elevated CA125 levels.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The rationale for our study is based on the association between a rise in the CA125 marker during follow up of patients in complete remission and recurrence, even with CA125 serum levels lower than the normal range.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">6</span></a> Fluorodeoxyglucose ([<span class="elsevierStyleSup">18</span>F]FDG) positron emission tomography/computed tomography (PET/CT) has been employed for years in cases of elevation of tumour markers with inconclusive imaging techniques, but it could detect ovarian recurrences, even with those titles of CA125.<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">7–9</span></a> Thus, the aim of our work was to assess CA125 and its kinetic values, expressed as CA125 velocity (CA125vel) and CA125 doubling time (CA125dt), as well as [<span class="elsevierStyleSup">18</span>F]FDG-PET/CT in the detection of ovarian cancer relapse and to evaluate the optimal values for CA125, CA125vel and CA125dt to select patients on whom to perform [<span class="elsevierStyleSup">18</span>F]FDG-PET/CT for ovarian cancer recurrence.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">This study was performed with institutional review board approval, and informed written consent was obtained from each patient. We retrospectively enrolled consecutive patients with suspicion of epithelial ovarian cancer recurrence referred to our centre during the period of 2007–2015 for [<span class="elsevierStyleSup">18</span>F]FDG-PET/CT. All patients had been treated for ovarian cancer, with complete remission after treatment for at least 6 months, i.e. no evidence of disease from tests, physical exams or conventional imaging techniques. The suspicion of recurrence was based on elevated CA125 serum levels, alterations observed with conventional imaging techniques (computed tomography [CT] or magnetic resonance imaging [MRI]) and/or by the appearance of symptoms. Inclusion criteria were: (1) complete remission for more than 6 months after treatment, (2) high CA125 serum levels at diagnosis and (3) measurement of CA125 serum levels on two consecutive occasions, to calculate the kinetic values. Patients referred twice to our centre who met the inclusion criteria were included in the analysis in both cases. Patients referred to assess response to treatment or progression suspect were excluded.</p><p id="par0020" class="elsevierStylePara elsevierViewall">For CA125 serum levels, the reference normal limit considered was 35<span class="elsevierStyleHsp" style=""></span>U/ml. The variation in CA125 levels was evaluated by using at least two measurements. CA125 velocity (CA125vel) was calculated according to the following formula: <span class="elsevierStyleItalic">(CA125a</span>–<span class="elsevierStyleItalic">CA125b)/time</span>. <span class="elsevierStyleItalic">CA125a</span> is the CA125 serum level closest to the PET/CT scan, with a maximum of 1 month between the scan and the measurement, <span class="elsevierStyleItalic">CA125b</span> is the measurement immediately preceding CA125a and <span class="elsevierStyleItalic">time</span> is the time in months between the two measurements. CA125 doubling time (CA125dt) was calculated by natural log of 2 (0.693) divided by the slope of the relationship between the log of CA125 and the time of CA125 measurement for each patient.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Imaging protocol and analysis</span><p id="par0025" class="elsevierStylePara elsevierViewall">A hybrid PET-CT scanner was used to obtain images 60<span class="elsevierStyleHsp" style=""></span>min after administration of 370<span class="elsevierStyleHsp" style=""></span>MBq of [<span class="elsevierStyleSup">18</span>F]FDG. Images were obtained from the orbitomeatal line to the proximal third of the lower limbs. First, low-dose CT images were acquired (120<span class="elsevierStyleHsp" style=""></span>kV, 80<span class="elsevierStyleHsp" style=""></span>mA), followed by PET in three-dimensional (3D) mode with an acquisition time of 3<span class="elsevierStyleHsp" style=""></span>min per bed. PET/CT images were reviewed by two experienced nuclear medicine physicians who were unaware of the clinical data, and the diagnosis was reached by consensus. The diagnosis of recurrence was decided by the visual analysis of fusion images, independently of the FDG activity measured by the maximum standard uptake value (SUVmax). [<span class="elsevierStyleSup">18</span>F]FDG-PET/CT were classified as normal if there was no uptake outside of expected physiological locations. [<span class="elsevierStyleSup">18</span>F]FDG uptake concordant with an area of inflammation on the CT image was considered as negative. All the areas with an increased tracer uptake above the background in sites consistent with disease localizations were considered positive and therefore compatible with relapse. All ambiguous cases were defined by consensus.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The confirmation of the disease was made by surgery or by clinical–radiological follow up, longer than 6 months and with at least 2 imaging techniques.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Data analysis</span><p id="par0035" class="elsevierStylePara elsevierViewall">Statistical analysis of data was carried out by using IBM SPSS statistical software v. 19.0<span class="elsevierStyleSup">®</span>. The descriptive statistical parameters were calculated and assessed as average, minimum, maximum and standard deviation (SD). The receiver operating characteristic (ROC) curve was generated and assessed to find the best cut-off point for CA125, CA125vel and CA125dt to predict recurrence. Differences between groups with normal and abnormal CA125 serum levels were calculated by chi-square test. <span class="elsevierStyleItalic">P</span> values<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05 were considered to indicate significant results.</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0040" class="elsevierStylePara elsevierViewall">During the enrolment period, we performed 59 [<span class="elsevierStyleSup">18</span>F]FDG-PET/CT scans in 48 patients [mean age (SD) 59.96 years (12.6)] with suspicion of recurrent epithelial ovarian cancer who met the inclusion criteria. Just one patient was referred twice due to the symptoms (abdominal pain), while in the rest of the patients had alterations in conventional imaging techniques or increased tumour markers, without collecting clinical data of these. Tumour characteristics are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. A total of 44 of these studies corresponding to 35 patients showed pathological [<span class="elsevierStyleSup">18</span>F]FDG uptake and were finally diagnosed with ovarian cancer recurrence. Of them, 22 were diagnosed after surgery or histological analysis (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), whereas the remaining 22 cases were diagnosed by clinical and radiological follow up after treatment administration. In 15 cases, a normal distribution of [<span class="elsevierStyleSup">18</span>F]FDG, or inflammatory disease (pulmonary involvement – pneumonia – and inguinal lymph nodes, that had fatty centre), were observed and categorized as non-recurrence, which was confirmed by clinical and radiological follow up, with a mean of 24 months (SD 14). From the 18 cases with CA125 serum level below the normal limit (35<span class="elsevierStyleHsp" style=""></span>U/ml) and from the 41 cases of CA125 greater than 35<span class="elsevierStyleHsp" style=""></span>U/ml, 7 and 37, respectively, were diagnosed with recurrence. In each group, 5 and 17 cases were confirmed by histological analysis (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Although the PET/CT diagnosis was made by visual analysis, the SUVmax in each study was calculated and compared with the CA125 parameters. There was no correlation with CA125 (<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.234, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.075) nor with CA125vel (<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.145, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.272), but there was a slight correlation with CA125dt (<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.270, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.039).</p><p id="par0050" class="elsevierStylePara elsevierViewall">The ROC analysis demonstrated an optimal cut-off value for CA125 at the moment of suspicion of 23.95<span class="elsevierStyleHsp" style=""></span>U/ml, achieving a sensitivity of 90.9% and a specificity of 73.3%, with an area under the curve (AUC) of 0.835 (CI 95% 0.710–0.960) in the prediction of recurrence. Regarding the aim of using kinetic values of CA125 to detect recurrence, we observed an optimal cut-off for CA125dt of 3.36 months (sensitivity 54.5%, specificity 73.3%) with an AUC of 0.728 (CI 95% 0.547–0.909). On the other hand, the analysis of the CA125vel revealed a cut-off of 1.96<span class="elsevierStyleHsp" style=""></span>U/ml/month (sensitivity of 86.4%, specificity of 80%), with an AUC of 0.849 (CI 95% 0.713–0.986). For SUVmax, the AUC was 0.982 (CI 95% 0.948–1.000), and the optimal cut-off was 2.05 (sensitivity 100%, specificity 93.3%). These results are represented in <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Globally, all tumour marker variables showed higher values in patients with recurrence than in those free of disease (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Mean CA125 serum level was 155.97<span class="elsevierStyleHsp" style=""></span>U/ml (SD 222.88) in patients with recurrent ovarian cancer, while in patients without recurrence, it was 33.33<span class="elsevierStyleHsp" style=""></span>U/ml (SD 54.59) (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.040). Mean CA125dt was 0.22 months (SD 29.93) and −16.05 (SD 42.33) in patients with and without recurrence, respectively (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.109). Likewise, CA125vel appeared higher in patients with relapse (mean 26.66<span class="elsevierStyleHsp" style=""></span>U/ml/months, SD 42.26), than in patients without it (mean 9.49, SD 34.57), but this difference was not significant (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.162). The sample was divided into two groups in relation to the CA125 reference level: normal (≤35<span class="elsevierStyleHsp" style=""></span>U/ml) or abnormal (>35<span class="elsevierStyleHsp" style=""></span>U/ml). When we selected the group of patients with normal CA125 serum levels, in which 7 of 18 cases were diagnosed with ovarian cancer recurrence (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>), we observed a higher mean CA125 in patients with recurrence (17.40<span class="elsevierStyleHsp" style=""></span>U/ml, SD 9.6) than in patients without disease (9.63<span class="elsevierStyleHsp" style=""></span>U/ml, SD 6.57) (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.045). The mean CA125vel was 1.57<span class="elsevierStyleHsp" style=""></span>U/ml per month (SD 1.93) and 0.09<span class="elsevierStyleHsp" style=""></span>U/ml per month (SD 0.58) in recurrence and non-recurrence cases, respectively (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.029). While the CA125dt did not show significant differences, with a mean of −27.14 months (SD 72.13) in the recurrent subgroups and a mean of −22.52 (SD 48.20) in the non-recurrence one (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.872).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">In the group of patients with CA125 serum levels above the normal limit, CA125 values in cases of recurrence (mean 182.20<span class="elsevierStyleHsp" style=""></span>U/ml, SD 234.24) were not significantly different from those in the disease-free group (mean 98.50<span class="elsevierStyleHsp" style=""></span>U/ml, SD 77.75) (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.486). Similar results were obtained for CA125vel, with a mean of 31.41<span class="elsevierStyleHsp" style=""></span>U/ml per month (SD 44.57) and 35.34<span class="elsevierStyleHsp" style=""></span>U/ml per month (SD 66.04), respectively (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.874), and for CA125dt, with a mean of 5.39 months (SD 5.49) and 1.72 months (SD 6.77), respectively (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.221) (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0065" class="elsevierStylePara elsevierViewall">The CA125 serum level is the most used tumour marker in the detection of ovarian cancer recurrence. Classically, the normal value was 35<span class="elsevierStyleHsp" style=""></span>U/ml,<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">10</span></a> but reference values have since changed due to the possible elevation of CA125 for reasons unrelated to ovarian cancer. Patients must show evidence of CA125 greater than or equal to two times the upper limit of the reference range or nadir value on two occasions at least 1 week apart to be considered as having a recurrence.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">10</span></a> In addition, an absolute increase in serum CA125 levels of ≥5<span class="elsevierStyleHsp" style=""></span>U/ml compared with baseline CA125 nadir values is predictive of recurrence.<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">11,12</span></a> In our series, all patients referred for suspected recurrent ovarian cancer with two known measurements of CA125 who first underwent a [<span class="elsevierStyleSup">18</span>F]FDG-PET/CT were selected, considering for the analysis the normal limit of CA125 as 35<span class="elsevierStyleHsp" style=""></span>U/ml. That reference value in our sample achieves a sensitivity and specificity of 84.09% and 73.33%, respectively.</p><p id="par0070" class="elsevierStylePara elsevierViewall">On the other hand, [<span class="elsevierStyleSup">18</span>F]FDG-PET/CT correctly catalogued all cases, regardless of the level of CA125 (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>), with a high prevalence of recurrence (74.58%). The fact that PET/CT has a high diagnostic value, even with CA125 levels below the normal limit, is reflected in the optimal cut-off value obtained by ROC analysis, with a value of 23.95<span class="elsevierStyleHsp" style=""></span>U/ml. Although it is slightly higher than that observed in other publications,<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">7,9,13</span></a> it achieves a sensitivity of 90.9% and a specificity of 73%. Because the absolute value of CA125 is not capable of detecting relapse, we believe kinetic parameters can facilitate diagnosis.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Some authors have described an association of CA125dt with a worse prognosis and a higher risk of recurrence. Han et al.,<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">14</span></a> in a series of 296 patients, noticed that patients with a doubling time longer than 40 days had a better outcome than those with a shorter doubling time (22.1 months vs 10.6 months). On the other hand, the work of Varughese et al.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">15</span></a> describes that a doubling of serum CA125 from its nadir is highly and strongly predictive of recurrence, even if the CA125 level is still within the upper limit of normal. However, in our sample, of all the parameters studied, CA125dt is the least useful, as can be observed in the AUC results. The CA125dt AUC was 0.728, while that of CA125vel was 0.849. This result is concordant with previous research by Xu et al.,<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">16</span></a> who reported that, although the doubling time from 3<span class="elsevierStyleHsp" style=""></span>U/ml to 6<span class="elsevierStyleHsp" style=""></span>U/ml was the same as that from 30<span class="elsevierStyleHsp" style=""></span>U/ml to 60<span class="elsevierStyleHsp" style=""></span>U/ml, the latter provided a stronger indication for relapse. According to Xu et al., the rate of increase in CA125 and the time interval are both predictors of ovarian cancer.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Globally, CA125vel in our series was higher in patients with positive PET/CT than in the non-recurrent group according to PET/CT. This result is consistent with the work of Levy et al.,<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">17</span></a> in which 52 patients were assessed by CA125 elevation above the normal limit. It was evident that patients with a pattern of abrupt rise of CA125 had a worse prognosis than those with a progressive increase. In our work, this difference in the elevation of CA125 was notable in patients who maintained CA125 serum levels within normal limits, in which we observed significant differences. Therefore, we believe that, in patients with ovarian cancer history, especially those with normal CA125 serum levels, the assessment of CA125vel is essential.</p><p id="par0085" class="elsevierStylePara elsevierViewall">In the same way, an absolute increase of 5<span class="elsevierStyleHsp" style=""></span>U/ml within the normal range in the CA125 serum level is a strong predictive factor for disease recurrence in patients who have achieved a complete remission. The same conclusion was drawn in a study of 96 patients with ovarian cancer who achieved a complete clinical, radiological and biochemical response and were followed up by observation.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">11</span></a> The authors related that the long median interval from the time of an absolute increase in CA125 to the time of documented recurrent disease can be explained by the practice of confirming CA125 serum levels on two successive occasions at least 4 weeks apart. In our opinion, the inclusion of CA125vel in daily practice could reduce the interval time to the confirmation of relapse, and its calculation by means of a simple formula is not time consuming. Therefore, according to our results, a CA125vel higher than 1.96<span class="elsevierStyleHsp" style=""></span>U/ml/month may indicate that a more thorough assessment of these patients is warranted and that they be referred for [<span class="elsevierStyleSup">18</span>F]FDG-PET/CT to diagnose recurrence as early as possible and select the most appropriate therapeutic plan for each patient. In our series, PET/CT allowed us to select site-specific therapy in 22 cases (37.28%), 5 of them with CA125 within the normal range and 17 with increased CA125, whereas in the remaining relapsed cases, a systemic treatment was applied. These results are in line with those published by Ebina et al.,<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">13</span></a> who concluded that PET/CT is helpful in optimizing the management plan in patients with recurrent ovarian cancer. They further asserted that PET/CT is a useful tool for selecting candidates for cytoreductive surgery, because localized FDG uptake patterns are the best candidates for surgical therapy. In this way, PET/CT avoids the administration of chemotherapy in patients because of a single elevation of the tumour marker, as happened in our series, because it has been demonstrated that there is no improvement in the survival of these patients.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">5</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Diagnosis with PET/CT is based not only on [<span class="elsevierStyleSup">18</span>F]FDG uptake but also on the visual evaluation of this and its correspondence with the morphological image. The SUVmax helps in the detection of disease, and a higher value is usually associated with tumour lesions, but its use individually without the visual analysis did not increase diagnostic accuracy. SUVmax had been employed to discriminate malignant ovarian tumours from benign lesions with cut-off levels around 3,<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">18,19</span></a> but [<span class="elsevierStyleSup">18</span>F]FDG uptake is influenced by multiple factors, both for the patient (weight, serum glucose levels, etc.) and for the tumour itself (histological subtypes, cellular proliferation, Ki 67, etc.).<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">20,21</span></a> In our opinion, an increase in [<span class="elsevierStyleSup">18</span>F]FDG uptake that does not correspond to physiological or inflammatory activity should be considered as pathological, independently of a low SUVmax. Above all, in a large percentage of patients, tumour lesions are subcentimetric, and their metabolic activity may be underestimated, although the SUVmax threshold of 2.05 obtained after the ROC analysis showed a high diagnostic yield.</p><p id="par0095" class="elsevierStylePara elsevierViewall">The main limitation of our study is its retrospective character and the small number of patients that composed the sample, in part due to the detailed inclusion criteria, which limited the sample to platinum-sensitive patients with recurrence after at least 6 months of complete remission. There was a selection bias, because patients were select from the PET/CT database, and only patients with two known measurements of CA125 were included. Another weakness is the fact that it was not possible to confirm all patients histologically, but the confirmation of all alterations would not have been ethical solely for validation of PET/CT. That is because conducting aggressive exploration could delay treatment administration in cases with disseminated disease, where there is no doubt of affectation, and could generate unwanted complications.</p><p id="par0100" class="elsevierStylePara elsevierViewall">To our best knowledge, this is the first work to compare PET/CT findings and CA125 kinetic parameters in ovarian cancer relapse after a complete remission period. Nevertheless, further prospective studies need to be conducted to confirm these results.</p><p id="par0105" class="elsevierStylePara elsevierViewall">In conclusion, in monitoring patients with ovarian cancer history, CA125 measurement is essential for the detection of recurrence, although relapse may occur with normal CA125 serum levels. Therefore, CA125 kinetic parameters must be considered, particularly in patients with CA125 serum levels within normal limits (≤35<span class="elsevierStyleHsp" style=""></span>U/ml), in which, according to our results, higher CA125vel is indicative of recurrence. PET/CT with [<span class="elsevierStyleSup">18</span>F]FDG is proven to be more accurate than CA125 serum level for detecting ovarian cancer recurrence despite a low SUVmax. PET/CT has a high diagnostic yield even with low levels of CA125, with a cut-off threshold of 23.9<span class="elsevierStyleHsp" style=""></span>U/ml.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflict of interest</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1062770" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1011121" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1062769" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Fundamento y objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1011120" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and methods" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Imaging protocol and analysis" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Data analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflict of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-02-09" "fechaAceptado" => "2017-11-02" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1011121" "palabras" => array:6 [ 0 => "[<span class="elsevierStyleSup">18</span>F]FDG-PET/CT" 1 => "CA125" 2 => "Velocity" 3 => "Doubling time" 4 => "Ovarian cancer" 5 => "Recurrence" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1011120" "palabras" => array:6 [ 0 => "[<span class="elsevierStyleSup">18</span>F]FDG-PET/TC" 1 => "CA125" 2 => "Velocidad" 3 => "Tiempo de duplicación" 4 => "Cáncer de ovario" 5 => "Recidiva" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To assess the usefulness of cancer antigen 125 (CA125) serum levels and kinetic values, velocity (CA125vel) and doubling time (CA125dt), as well as fluorodeoxyglucose ([<span class="elsevierStyleSup">18</span>F]FDG) positron emission tomography/computed tomography (PET/CT), in the detection of ovarian cancer recurrence. To assess the optimal cut-off for CA125, CA125vel and CA125dt to detect relapse with [<span class="elsevierStyleSup">18</span>F]FDG-PET/CT.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A retrospective analysis was performed of 59 [<span class="elsevierStyleSup">18</span>F]FDG-PET/CT (48 patients) for suspected recurrence of ovarian cancer. Receiver operating characteristic (ROC) curves were plotted and area-under-the curve (AUC) statistics were computed for CA125, CA125vel and CA125dt. The results obtained in the group with normal and high (>35<span class="elsevierStyleHsp" style=""></span>U/ml) CA125 levels were compared.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Forty-four cases of recurrence were diagnosed (7 had CA125 ≤35<span class="elsevierStyleHsp" style=""></span>U/ml), whereas 15 showed no disease. All of them were correctly catalogued by PET/CT. In ROC analysis, the discriminatory power of CA125 was relatively high (AUC 0.835) and the optimal cut-off point to reflect active disease was 23.9<span class="elsevierStyleHsp" style=""></span>U/ml. The ROC analyses for the CA125vel and CA125dt showed an AUC of 0.849 and 0.728, respectively, with an optimal cut-off point of 1.96<span class="elsevierStyleHsp" style=""></span>U/ml/month and 0.76 months, respectively. In patients with normal CA125 and recurrence of ovarian cancer, the CA125vel was significantly higher than in patients without recurrence (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.029).</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">[<span class="elsevierStyleSup">18</span>F]FDG-PET/CT is more accurate than CA125 parameters in the detection of ovarian cancer recurrence. CA125 serum levels are essential; nevertheless, CA125 kinetic values must be considered to detect relapse. Particularly in patients with CA125 within normal values, in which a higher CA125vel is indicative of recurrence.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Fundamento y objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Valorar en la recidiva del cáncer de ovario la utilidad del CA125 y sus parámetros cinéticos, velocidad (CA125vel) y tiempo de duplicación (CA125td), y de la tomografía por emisión de positrones/tomografía computarizada (PET/TC) con fluorodesoxiglucosa ([<span class="elsevierStyleSup">18</span>F]FDG). Determinar el valour óptimo del CA125, CA125vel y CA125td para detectar recidiva con [<span class="elsevierStyleSup">18</span>F]FDG-PET/TC.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Análisis retrospectivo de 59 estudios [<span class="elsevierStyleSup">18</span>F]FDG-PET/TC en 48 pacientes con sospecha de recidiva de cáncer de ovario platino-sensible. Realizamos un análisis ROC (Receiver operating characteristic) y el área bajo la curva (AUC) para el CA125, CA125vel, CA125td. Comparamos los resultados entre los grupos con CA125 dentro de la normalidad y CA125 patológico (>35<span class="elsevierStyleHsp" style=""></span>U/ml).</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Fueron diagnosticados de recidiva 44 casos (7 con CA125 ≤35<span class="elsevierStyleHsp" style=""></span>U/ml), mientras que 15 no mostraron recurrencia. Todos ellos fueron correctamente catalogados mediante la PET/TC. La curva ROC demostró una capacidad discriminatoria del CA125 relativamente alta (AUC 0.835), con un valour óptimo de referencia de 23.9<span class="elsevierStyleHsp" style=""></span>U/ml. El análisis ROC para la CA125vel y el CA125td mostró un AUC de 0.849 y 0.728, con un valour de referencia de 1.96<span class="elsevierStyleHsp" style=""></span>U/ml/mes y 0.76 meses, respectivamente. En las pacientes con CA125 en límites normales la CA125vel fue significativamente mayor en las pacientes con recidiva que en aquellas sin enfermedad (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.029).</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusión</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La [<span class="elsevierStyleSup">18</span>F]FDG-PET/TC es más exacta que los parámetros de CA125 en la detección de recurrencia de cáncer de ovario. Los niveles séricos de CA125 resultan esenciales, no obstante, los parámetros cinéticos deben ser tenidos en cuenta en la detección de la recidiva.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Fundamento y objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2093 "Ancho" => 2500 "Tamanyo" => 274397 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">[<span class="elsevierStyleSup">18</span>F]FDG-PET/CT in a 60-year-old woman with recurrent ovarian cancer (FIGO stage IIIC, high grade serous carcinoma) and increased CA125 level (97.3<span class="elsevierStyleHsp" style=""></span>U/ml), CA125dt of 1.26 months and CA125vel of 27.57<span class="elsevierStyleHsp" style=""></span>U/ml per month. (A) MIP (maximum intensity projection), (B) and (C) axial fusion images showing histopathologically confirmed retroperitoneal lymph nodes (arrows).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1224 "Ancho" => 1499 "Tamanyo" => 73623 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">ROC curves for SUVmax, CA125, CA125vel and CA125dt. The analysis demonstrated an optimal cut-off value for CA125 serum level of 23.95<span class="elsevierStyleHsp" style=""></span>U/ml, for the CA125dt of 3.36 months and for the CA125vel of 4.56<span class="elsevierStyleHsp" style=""></span>U/ml per month. The AUC for CA125, CA125dt and CA125vel were respectively of 0.835 (CI 95% 0.710–0.960), 0.728 (CI 95% 0.547–0.909), 0.8469 (CI 95% 0.713–0.986). The optimal cut-off of SUVmax is 2.05, and the AUC 0.982 (CI 95% 0.948–1.000).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 2483 "Ancho" => 2524 "Tamanyo" => 237225 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Comparison of CA125 (A), CA125dt (B), CA125vel (C) and SUVmax (D) in both groups, with tumour marker within normal and above the reference normal limit, based on final diagnosis.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 944 "Ancho" => 1800 "Tamanyo" => 166366 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">[<span class="elsevierStyleSup">18</span>F]FDG-PET/CT (A: MIP) in a 45-year-old female with a history of high-grade serous ovarian cancer, stage III. She presented a CA125 serum value of 26.50<span class="elsevierStyleHsp" style=""></span>U/ml, with a rate of increase (CA125vel) of 5.16<span class="elsevierStyleHsp" style=""></span>U/ml per month and a CA125dt of 2.36 months. (B) Axial fusion PET/CT images present multiple hypermetabolic lesions, most of them millimetric, with SUVmax 4.8, with pelvic lymph nodes (arrow) and mesenteric involvement (head arrows). The patient was treated with chemotherapy.</p>" ] ] 4 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Characteristic \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span> patients/<span class="elsevierStyleItalic">N</span> studies PET/CT \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Histological type</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Serous adenocarcinoma (low grade) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3/3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Serous adenocarcinoma (high grade) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">31/41 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Endometrioid adenocarcinoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10/11 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Clear cell adenocarcinoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1/1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mucinous adenocarcinoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3/3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">FIGO stage at diagnosis</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10/11 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6/6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">28/38 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>IV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4/4 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1812066.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Tumour characteristic and stage at the moment of diagnosis.</p>" ] ] 5 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CA125 serum levels \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">PET/CT results \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Surgical confirmation/total \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">≤35<span class="elsevierStyleHsp" style=""></span>U/ml \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Positive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5/7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0/11 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">>35<span class="elsevierStyleHsp" style=""></span>U/ml \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Positive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">17/37 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0/4 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1812065.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Confirmation of disease in relation to the diagnostic techniques.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:21 [ 0 => array:3 [ "identificador" => "bib0110" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Newly diagnosed and relapsed epithelial ovarian carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. 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Journal Information
Original article
Usefulness of CA125 and its kinetic parameters and positron emission tomography/computed tomography (PET/CT) with fluorodeoxyglucose ([18F] FDG) in the detection of recurrent ovarian cancer
Utilidad del CA125 y sus parámetros cinéticos y de la tomografía por emisión de positrones/tomografía computarizada (PET/TC) con fluorodesoxiglucosa ([18F]FDG) en la detección de la recidiva del cáncer de ovario
Azahara Palomar Muñoza,b,
, José Manuel Cordero Garcíaa,c, Prado Talavera Rubioa, Ana M. García Vicentea, Beatriz González Garcíaa, María Emiliana Bellón Guardiaa, Ángel Soriano Castrejóna, Enrique Aranda Aguilard
Corresponding author
a Servicio de Medicina Nuclear, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
b Servicio de Medicina Nuclear, Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
c Servicio de Medicina Nuclear, Hospital Universitario La Paz, Madrid, Spain
d Servicio de Oncología Médica, Hospital Universitario Reina Sofía, Córdoba, Spain