Clinical value of metabolic PET parameters of primary vulvar carcinoma | Revista Española de Medicina Nuclear e Imagen Molecular (English Edition)

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Vulvar squamous cell carcinomas &#40;VSCC&#41; account for around 90 percent of all vulvar cancers&#44; which in turn account for 4 percent of all gynecological malignancies&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The remaining 10 percent consist of melanomas&#44; basal cell carcinomas&#44; sarcomas and adenocarcinomas&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Vulvar cancer is surgically and pathologically staged based on the system introduced by the International Federation of Gynecology and Obstetrics &#40;FIGO&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The staging was revised by FIGO in 2009&#46; Smoking&#44; human papilloma virus infections&#44; immunosuppression and inflammatory lesions like lichen sclerosis are important risk factors for vulvar cancers&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The disease is typically detected when confined to the perineum&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The main mode of spread of vulvar cancer is lymphogenic to the inguinofemoral lymph nodes&#44; while distant metastases are rare&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Inguinofemoral lymph nodes are positive in 30&#37; of vulvar cancer cases&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> The 5-year survival is 90 percent in cases without lymph node involvement&#44; while this rate drops to 53 percent in the presence of lymph node involvement&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Lymph node involvement alone is the most important prognostic factor&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Among the risk factors for nodal involvement are poor histologic differentiation&#44; tumor thickness&#44; lymphovascular invasion and patient age &#62;55 years&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Additional pathologic prognostic factors include the depth of stromal invasion and lymph-vascular space invasion&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In the past&#44; surgical interventions for advanced vulvar cancers &#40;Stages III and IV&#41; were resulting in high mortality and morbidity&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Currently&#44; more conservative surgery can be performed following radiotherapy or chemoradiation in locally advanced vulvar cancers&#46; As such&#44; accurate preoperative staging is of critical importance in establishing the margins of groin surgery and to identify patients eligible for minimally invasive procedures&#59; thereby&#44; unnecessary inguinofemoral lymph node dissection is avoided&#44; which has been associated with high morbidity and a poorer quality of life&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">F-18 fluorodeoxyglucose &#40;FDG&#41; positron emission tomography&#47;computed tomography &#40;PET&#47;CT&#41; is increasingly used for the assessment of gynecological cancers&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> Given the low incidence of vulvar cancer&#44; there is very limited data on the benefit of imaging studies in the staging and monitoring of such patients&#46; There have been several studies assessing the lymph nodes in vulvar cancers&#46; Nevertheless&#44; we could identify no study investigating volumetric PET parameters&#44; which provide information on the tumor load of primary vulvar lesions&#46; The aim of the present study is to determine the effect of PET&#47;CT on the assessment of vulvar cancer patients and for predicting prognosis&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and method</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Patients</span><p id="par0025" class="elsevierStylePara elsevierViewall">Our retrospective study included 47 patients diagnosed with VSCC by biopsy who underwent a pretreatment PET&#47;CT scan between January 2015 and June 2019&#46; In the pretreatment period&#44; cervical smears were taken&#44; HPV tests were performed&#44; and a cystoscopy and rectoscopy were performed on cases with suspected bladder or anal invasion&#46; Since FDG is excreted in the urinary tract&#44; patients with urethral involvement were excluded from the study due to the potential effect on volumetric PET parameters&#46; For patients with suspected urinary contaminations&#44; an additional scan was performed after the genital region was cleaned&#46; For all patients&#44; the baseline PET parameters of primary tumor&#44; and the maximum standardized uptake value &#40;SUVmax&#41;&#44; mean standardized uptake value &#40;SUVmean&#41;&#44; metabolic tumor volume &#40;MTV&#41; and total lesion glycolysis &#40;TLG&#41; values were recorded&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">PET&#47;CT imaging and assessment</span><p id="par0030" class="elsevierStylePara elsevierViewall">PET&#47;CT images were acquired using a PHILIPS GEMINI TF 16 Slice PET&#47;CT scanner&#46; The patients were administered F-18 FDG intravenously when their blood glucose level was &#60;180<span class="elsevierStyleHsp" style=""></span>mg&#47;dl following an 8-hour fasting period&#46; First CT &#40;140<span class="elsevierStyleHsp" style=""></span>kV&#44; 100<span class="elsevierStyleHsp" style=""></span>mAs&#44; 5-mm slice thickness&#41; and then PET &#40;1&#46;5<span class="elsevierStyleHsp" style=""></span>min per bed position&#41; images were acquired approximately 60<span class="elsevierStyleHsp" style=""></span>min after the injection&#46; The attenuation correction was made using the CT data&#46; A three-dimensional isocontour region of interest of the primary tumor was drawn&#46; The SUVmax of the primary tumor in the region of interest was measured&#46; The SUVmean and MTV values were obtained considering 40 percent of SUVmax as the threshold&#46; The TLG value was calculated by multiplying the SUVmean and MTV values&#46; For statistically significant PET parameters&#44; a receiver operating characteristics &#40;ROC&#41; were drawn&#44; the area under the curve &#40;AUC&#41; was calculated and the optimum cut-off values were determined&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The PET&#47;CT images were evaluated together by two experienced nuclear medicine physicians&#46; In cases that consensus could not be reached&#44; the final decision was made after discussing with the third nuclear medicine physicians&#46; With the exception of the areas of physiological FDG uptake&#44; the lesions with a higher FDG uptake than the pelvic muscle structures&#44; which are considered as background&#44; and with CT equivalents were accepted as positive findings&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Treatment</span><p id="par0040" class="elsevierStylePara elsevierViewall">Eligible cases underwent surgery within 20 days of the PET&#47;CT acquisition&#46; Ipsilateral inguinofemoral lymphadenectomy and radical&#47;wide local excision were performed on early stage tumors measuring &#8805;1<span class="elsevierStyleHsp" style=""></span>cm from the midline structures&#46; When the ipsilateral lymph node was positive&#44; a contralateral lymphadenectomy was performed&#46; Radical tumor excision and bilateral inguinofemoral lymphadenectomy were performed on tumors with midline localizations&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Radical vulvectomy and bilateral inguinofemoral lymphadenectomy were performed on advanced stage patients&#44; or such cases were evaluated for surgery following radiotherapy&#47;chemoradiation&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Cases with a detected lymph node metastasis were administered adjuvant radiotherapy&#46; Patients were called for follow-up visits every three months for the first two years&#44; and every six months for the third and fourth years following primary surgical treatment&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">PET&#47;CT findings were assessed based on postoperative histopathological data&#44; which is accepted as the reference method&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Survival</span><p id="par0060" class="elsevierStylePara elsevierViewall">Overall survival &#40;OS&#41; was defined as the time from the date of diagnosis to death&#44; or to the date of last admission to our institution for those who survived&#46; Progression-free survival &#40;PFS&#41; was defined as the time from the date of diagnosis to the date of progression&#44; or to the date of death of those without progression&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The survival curves of the patients were created using the Kaplan&#8211;Meier method&#46; A Log-Rank test was used to compare the difference in OS and PFS among the patients grouped by tumor diameter&#44; stage and lymph node metastasis&#46; The Cox proportional hazards regression model was used for the analysis of the association between continuous variables &#40;age&#44; SUVmax&#44; SUVmean&#44; MTV&#44; TLG&#41; and OS and PFS&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Additionally&#44; an independent <span class="elsevierStyleItalic">t</span>-test was used to compare the mean age and the mean SUVmax&#44; SUVmean&#44; MTV and TLG values of the primary tumor between patients with a negative and those with a positive lymph node metastasis&#46; A <span class="elsevierStyleItalic">p</span> value of &#60;0&#46;05 was considered significant for all statistical analyses&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0075" class="elsevierStylePara elsevierViewall">The mean age of the 47 study patients was 69&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;9 years&#46; The mean duration of follow-up was 20&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;2 months&#46; During follow-up&#44; 31 patients died and 33 patients experienced progression&#46; The mean OS was 26<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;1 months and the mean PFS was 21&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;3 months&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">PET&#47;CT accurately detected all lesions that were evaluated as malignant upon a histopathological assessment &#40;47&#47;47&#59; 100&#37;&#41;&#46; Furthermore&#44; PET&#47;CT detected pelvic nodal metastasis in five cases&#44; both pelvic and para-aortic nodal metastasis in one case&#44; mediastinal lymph node metastasis in one case and distant organ metastasis in one case&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The largest diameter of the primary tumor was &#8805;4<span class="elsevierStyleHsp" style=""></span>cm in 20 patients and &#60;4<span class="elsevierStyleHsp" style=""></span>cm in 27 patients&#46; Among the patients&#44; 18 were in the early stage &#40;ES&#41; and 29 were in the advanced stage &#40;AS&#41;&#46; In an analysis of all patients&#44; the SUVmax of the primary tumor was 11&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;2&#44; the mean SUVmean was 6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;5&#44; the mean MTV was 13&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;4 and the mean TLG was 116&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>30&#46;2&#46; The overall characteristics are presented in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">OS and PFS were significantly longer in early stage patients than in advanced stage patients&#44; in patients with a tumor size &#60;4<span class="elsevierStyleHsp" style=""></span>cm than in those with a tumor size &#8805;4<span class="elsevierStyleHsp" style=""></span>cm&#44; and in patients with a negative lymph node metastasis than those with a positive lymph node metastasis &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">The age&#44; SUVmax&#44; SUVmean&#44; MTV and TLG values of the primary tumor were statistically significantly associated with OS and PFS &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; ROC curve was plotted to get a cut-off value for both OS and PFS&#46; PFS determinant optimum cut-off values for SUVmax&#44; SUVmean&#44; MTV and TLG are&#44; respectively&#44; 8&#46;5 &#40;sensitivity 76&#37;&#44; specificity 86&#37;&#44; AUC&#58; 0&#46;868&#41;&#44; 4&#46;2 &#40;sensitivity 88&#37;&#44; specificity 79&#37;&#44; AUC&#58; 0&#46;857&#41;&#44; 5&#46;5 &#40;sensitivity 72&#37;&#44; specificity 72&#37;&#44; AUC&#58; 0&#46;805&#41;&#44; 23&#46;4 &#40;sensitivity 81&#37;&#44; specificity 79&#37;&#44; AUC&#58; 0&#46;858&#41;&#46; OS determinant optimum cut-off values for SUVmax&#44; SUVmean&#44; MTV and TLG are&#44; respectively&#44; 8&#46;5 &#40;sensitivity 77&#37;&#44; specificity 82&#37;&#44; AUC&#58; 0&#46;868&#41;&#44; 4&#46;2 &#40;sensitivity 90&#37;&#44; specificity 75&#37;&#44; AUC&#58; 0&#46;857&#41;&#44; 5&#46;5 &#40;sensitivity 74&#37;&#44; specificity 69&#37;&#44; AUC&#58; 0&#46;805&#41;&#44; 23&#46;4 &#40;sensitivity 83&#37;&#44; specificity 75&#37;&#44; AUC&#58; 0&#46;858&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Furthermore&#44; the SUVmax&#44; SUVmean&#44; MTV and TLG values of the primary tumor were significantly higher in cases with lymph node metastasis than in those without such a metastasis &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0105" class="elsevierStylePara elsevierViewall">PET&#47;CT plays an important role in the assessment and therapeutic planning of gynecological tumors&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> The presence of lesions other than inguinal LN and vulva plays an important role in the staging&#44; treatment and prognosis of vulvar cancer patients&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> A previous study found PET&#47;CT to be likely to play an important role in the management of vulvar and vaginal carcinomas&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> The identification of positive pelvic nodes on PET&#47;CT may allow extensive surgery to be avoided in the patient&#44; with chemoradiotherapy prescribed as an alternative&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> It was stated that PET&#47;CT imaging can change the treatment plan&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> The study by Peiro et al&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> found that PET&#47;CT changed therapeutic management in eight &#40;61&#46;5&#37;&#41; of 13 cases&#46; In our study&#44; except inguinal lymph nodes in PET&#47;CT&#44; pelvic nodal metastasis in five cases&#44; pelvic and paraaortic node metastasis in one case&#44; mediastinal lymph node metastasis in one case&#44; and distant organ metastasis in one case were found and these lesions were not identified in other imaging methods&#46; Thereby&#44; PET&#47;CT contributed to the therapeutic management of these cases&#46; Differences in patient populations may cause different results between studies&#46; In the present study only cases diagnosed with VSCC were included&#44; whereas other studies included a small number of patients with different vulvar lesions&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">LN metastasis is considered to be the most important prognostic factor in cases of vulvar cancer&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#44;21</span></a> The status of inguinal LN and the presence of extra-vulvar lesions play an important role in the management and prognosis of vulvar cancer&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> In the study by Collarino et al&#46;&#44; age and lymph node status were identified as prognostic factors for PFS or OS&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Our study found age and presence of lymph node metastasis to be poor prognostic factors for vulvar cancer&#44; which is consistent with the findings of previous studies in literature&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Patients with a positive lymph node involvement are likely to have larger tumors and higher metabolic PET parameters&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> We also found the PET parameters of the primary tumor to be significantly higher in cases with detected lymph node metastasis&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">There is a significant interest in the evaluation of the metabolic characteristics of the primary lesion as prognostic factors&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> In the present study&#44; PET parameters of primary vulvar carcinoma were found as significant predictive factors for OS and PFS and the optimum cut-off values for SUVmax&#44; SUVmean&#44; MTV and TLG were determined&#46; Tumoral FDG uptake on PET&#47;CT indicates metabolic glucose activity&#44; and provides information about the tumor load&#46; Nevertheless&#44; urinary contamination is common in the vulvar region&#44; which makes evaluating the metabolic parameters of the primary lesion controversial&#46; We excluded cases with urethral involvement from our study due to the potential effect on PET parameters&#46; Furthermore&#44; the cases with an urinary contamination of the vulva were evaluated together with images obtained after cleaning&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conclusions</span><p id="par0125" class="elsevierStylePara elsevierViewall">Our study found the SUVmax&#44; SUVmean&#44; MTV and TLG values of the primary tumor to be statistically significantly associated with OS and PFS&#46; The limitations of the present study include the assessment of data from only a single center&#44; and the heterogenous patient population&#46; To the best of our knowledge&#44; however&#44; this is the first study to investigate the prognostic value of the PET parameters of primary tumors in patients with VSCC&#44; which we believe is its primary contribution to literature&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Ethics approval and consent to participate</span><p id="par0130" class="elsevierStylePara elsevierViewall">The present study was granted ethical approval at a meeting at our hospital dated 15&#46;05&#46;2020&#44; with Decision No&#46;&#58; 6&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Informed consent was obtained from all individual participants included in the study for participation&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Funding</span><p id="par0145" class="elsevierStylePara elsevierViewall">None&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflict of interest</span><p id="par0150" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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    "fechaRecibido" => "2020-07-06"
    "fechaAceptado" => "2020-08-18"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Purpose</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">We aim to establish the prognostic value of metabolic parameters of the primary tumor in patients diagnosed with vulvar squamous cell carcinoma &#40;VSCC&#41; who underwent a pretreatment F-18 FDG PET&#47;CT scan&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materials and Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This retrospective study included 47 patients with a histopathologically confirmed diagnosis of VSCC&#44; and who underwent a F-18 FDG PET&#47;CT scan prior to treatment&#46; The disease stage and age at diagnosis&#44; and the maximum standardized uptake value &#40;SUVmax&#41;&#44; SUVmean&#44; metabolic tumor volume &#40;MTV&#41; and total lesion glycolysis &#40;TLG&#41; values of the primary tumor&#44; based on a baseline PET scan&#44; were recorded&#46; The relationship between these factors&#44; and progression-free survival &#40;PFS&#41; and overall survival &#40;OS&#41; was evaluated&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The mean age of the 47 study patients was 69&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;9 years&#46; Among the patients&#44; 18 were in early stage of the disease and 29 were in the advanced stage&#46; The age&#44; and SUVmax&#44; SUVmean&#44; MTV and TLG values were statistically significantly associated with OS and PFS&#46; Furthermore&#44; it was noted that OS and PFS were significantly longer in the early stage patients than in the advanced stage patients&#44; in patients with a tumor size &#60;4<span class="elsevierStyleHsp" style=""></span>cm than those with a tumor size &#8805;4<span class="elsevierStyleHsp" style=""></span>cm&#44; and in patients with a negative lymph node metastasis than those with a positive lymph node metastasis&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Our findings suggest that PET parameters are prognostic factors for VSCC&#46; To the best of our knowledge&#44; this study is the first to investigate the prognostic value of the PET parameters of primary tumors in patients with VSCC&#44; and as such&#44; we believe it contributes to literature&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Nuestro prop&#243;sito es establecer el valor progn&#243;stico de los par&#225;metros metab&#243;licos del tumor primario en pacientes diagnosticadas de carcinoma vulvar de c&#233;lulas escamosas &#40;VSCC&#41; en las que se realiz&#243; un 18F- FDG PET&#47;TC pretratamiento&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Materiales y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">estudio retrospectivo que incluy&#243; 47 pacientes con un diagn&#243;stico histopatol&#243;gico confirmado de VSCC en las que se realiz&#243; un 18F- FDG PET&#47;TC antes del tratamiento&#46; Se registraron la fase de la enfermedad&#44; la edad de diagn&#243;stico y el valor estandarizado de captaci&#243;n m&#225;ximo &#40;SUVmax&#41;&#44; los valore de SUVmean&#44; del volumen de tumor metab&#243;lico &#40;MTV&#41; y de la glic&#243;lisis total de la lesi&#243;n &#40;TLG&#41; del tumor primario&#44; seg&#250;n una PET basal&#46; Se evalu&#243; la relaci&#243;n entre estos factores&#44; la supervivencia libre de progresi&#243;n &#40;PFS&#41; y la supervivencia global &#40;OS&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La edad media de las 47 pacientes del estudio era de 69&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;9 a&#241;os&#46; Entre las pacientes&#44; 18 estaban en la fase inicial de la enfermedad y 29 estaban en fase avanzada&#46; La edad y los valores de SUVmax&#44; SUVmean&#44; MTV y TLG estaban asociados de forma estad&#237;sticamente significativa con la OS y PFS&#46; Adem&#225;s&#44; se observ&#243; que OS y PFS era significativamente mayor en los pacientes en fases iniciales que en las pacientes en fase avanzada&#59; en pacientes con un tama&#241;o del tumor &#60;4<span class="elsevierStyleHsp" style=""></span>cm que en aquellas con un tama&#241;o del tumor de &#8805;4<span class="elsevierStyleHsp" style=""></span>cm y en pacientes con met&#225;stasis de ganglios linf&#225;ticos negativa respecto a aquellos con met&#225;stasis ganglionar positiva&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Nuestros resultados sugieren que los par&#225;metros del PET son factores pron&#243;sticos del VSCC&#46; Hasta donde sabemos&#44; este estudio es el primero en investigar el valor pron&#243;stico de los par&#225;metros PET de los tumores primarios en pacientes con VSCC&#44; y por esta raz&#243;n&#44; creemos que contribuye a la literatura especializada&#46;</p></span>"
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        "etiqueta" => "&#8902;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Yanarate&#351; A&#44; Budak E&#44; Budak A&#44; Inan AH&#44; Kanmaz AG&#44; Oral A&#44; et al&#46; Valor cl&#237;nico de los par&#225;metros metab&#243;licos del PET del carcinoma vulvar primario&#46; Rev Esp Med Nucl Imagen Mol&#46; 2021&#59;40&#58;367&#8211;371&#46;</p>"
      ]
    ]
    "multimedia" => array:4 [
      0 => 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"
          ]
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">ES&#44; early stage&#59; AS&#44; advanced stage&#59; SUVmax&#44; maximum standardized uptake value&#59; SUVmean&#44; mean standardized uptake value&#59; MTV&#44; metabolic tumor volume&#59; TLG&#44; total lesion glycolysis&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
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                0 => """
                  <table border="0" frame="\n
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Characteristic&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Patients &#40;n&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">47&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">69&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#60;4<span class="elsevierStyleHsp" style=""></span>cm&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8805;4<span class="elsevierStyleHsp" style=""></span>cm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Lymph node metastasis &#40;n&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Negative&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Positive&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">FIGO stage &#40;n&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ES &#40;stage 1&#8211;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">18&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>AS &#40;stage 3&#8211;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>SUV max&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">11&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>SUVmean&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>MTV&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">116&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>30&#46;2&nbsp;\t\t\t\t\t\t\n
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">OS&#44; overall survival&#59; PFS&#44; progression-free survival&#59; ES&#44; early stage&#59; AS&#44; advanced stage&#46; Significant values &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; are indicated with &#42;&#46;</p>"
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                  \t\t\t\t">31&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;7&nbsp;\t\t\t\t\t\t\n
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">OS&#44; overall survival&#59; PFS&#44; progression-free survival&#59; SUVmax&#44; maximum standardized uptake value&#59; SUVmean&#44; mean standardized uptake value&#59; MTV&#44; metabolic tumor volume&#59; TLG&#44; total lesion glycolysis&#46; Significant values &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; are indicated with &#42;&#46;</p>"
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