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Original Article
Clinical and prognostic value of 18F-FDG PET/CT in recurrent endometrial carcinoma
Valor clínico y pronóstico de la PET/TC con 18F-FDG en el cáncer de endometrio recurrente
Domenico Albanoa,
Corresponding author
doalba87@libero.it

Corresponding author.
, Valentina Ziziolib, Franco Odicinob, Raffaele Giubbinia, Francesco Bertagnaa
a Nuclear Medicine, University of Brescia and Spedali Civili Brescia, Brescia, Italy
b Department of Obstetrics and Gynecology, Spedali Civili Brescia, Brescia, Italy
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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">Endometrial carcinoma &#40;EC&#41; is a common gynecological cancer with an overall good prognosis&#44; except in cases of advanced EC or with recurrence&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">1&#44;2</span></a> Common symptomatology usually leads to early diagnosis and favorable survival in most cases&#44; but there is a subset of EC that presents poorer prognosis&#46; The 5-year survival for early-stage disease is as high as 95&#37; but it rapidly declines to 67&#37; for stage III and 16&#37; for stage IV disease&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">3</span></a> The treatment of EC usually involves surgery with or without adjuvant therapy &#40;radiotherapy&#44; chemotherapy or both&#41;&#59; the post-treatment surveillance includes physical examination&#44; conventional imaging &#40;CI&#41; studies&#44; like ultrasound&#44; computed tomography &#40;CT&#41; and&#47;or magnetic resonance imaging &#40;MRI&#41;&#44; and post-treatment serum levels of Cancer Antigen &#40;CA&#41; 125&#46; CA-125 has been shown to be a useful indicator of recurrence&#44; but may have low specificity being able to be associated with both benign and malignant conditions<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">4</span></a>&#59; moreover&#44; this marker cannot show the anatomical localization of recurrent disease&#46; Considering the poor prognosis of recurrent EC&#44; it is crucial to define an effective diagnostic modality in the management of patients who are suspected to have recurrence&#46; CI exams may not be very accurate in the detection of tumor recurrence<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">5</span></a>&#59; in fact it is difficult for these imaging modalities to correctly differentiate between tumor recurrence and postsurgical or post-radiotherapy changes&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">5</span></a> The fluorine-18-fluorodeoxyglucose positron emission tomography&#47;computed tomography &#40;<span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT&#41;&#44; if performed after an adequate time interval following therapy&#44; may be useful in this field&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The definite role of <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT in evaluating EC is not completely established&#46; Limited studies are available in the literature regarding the usefulness of <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT in recurrent EC<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">6&#8211;15</span></a> and some of these studies present limitations like the use of <span class="elsevierStyleSup">18</span>F-FDG PET alone without CT&#44;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">7&#8211;10</span></a> the heterogeneous population included &#40;cervical and endometrial cancers analyzed together&#41;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">11&#44;12</span></a> and the limited sample of patients included&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">9&#44;11&#44;14&#8211;16</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The aim of this retrospective study was to assess the diagnostic performance&#44; the prognostic value and the impact on therapeutic management of <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT in a large sample of patients with suspected recurrent endometrial carcinoma&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Patients</span><p id="par0020" class="elsevierStylePara elsevierViewall">We retrospectively evaluated 157 women &#40;average age 61&#46;8&#44; range 31&#8211;84&#41; with an histological diagnosis of endometrial carcinoma who underwent <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT for restaging purpose and suspected recurrence&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The clinical features of patients are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; All patients underwent abdominal hysterectomy plus bilateral salpingo-oophorectomy and in 56 cases bilateral pelvic lymphadenectomy was also performed&#46; Forty patients &#40;25&#37;&#41; did not receive postsurgical adjuvant therapy&#59; adjuvant external pelvic radiotherapy was administered in 60 cases &#40;39&#37;&#41;&#44; chemotherapy in 32 &#40;20&#37;&#41; cases and a combination of chemotherapy and radiotherapy in 25 &#40;16&#37;&#41;&#46; At the time of diagnosis&#44; 58 patients were in stage I according to The International Federation of Gynecology and Obstetrics &#40;FIGO&#41; classification&#44;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">17</span></a> 29 in stage II&#44; 62 in stage III and 8 in stage IV&#46; The most common EC histotype was endometrioid adenocarcinoma in 125 patients&#44; followed by serous carcinoma and clear cell carcinoma in 16 cases respectively&#46; Recurrence was suspected on the basis of elevated tumor marker levels &#40;considering CA 125 higher than 35<span class="elsevierStyleHsp" style=""></span>U&#47;mL&#41; in 18 women&#44; because of imaging findings on CI exams in 80 women&#44; due to clinical suspicion in symptomatic patients and higher CA125 level in 28 cases&#44; and because of both elevated CA 125 level and findings on CI in the remaining 31 patients&#46; Follow-up information was used to assess the disease status in order to evaluate the progression free survival &#40;PFS&#41;&#44; the overall survival &#40;OS&#41; and the impact of PET&#47;CT on the therapeutic approach &#40;change in therapy or &#8220;wait and watch&#8221; approach&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080"><span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT imaging and interpretation</span><p id="par0030" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT scans were performed in accordance with a standard whole-body oncological protocol following the guidelines of the European Association of Nuclear Medicine &#40;EANM&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">18</span></a><span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT was performed after at least 6<span class="elsevierStyleHsp" style=""></span>h fasting and with glucose level lower than 130<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#46; An activity of 3&#46;5&#8211;4&#46;5<span class="elsevierStyleHsp" style=""></span>MBq&#47;kg of <span class="elsevierStyleSup">18</span>F-FDG was administered intravenously and images were acquired 60<span class="elsevierStyleHsp" style=""></span>min after injection from the skull base to the mid-thigh on a Discovery ST PET&#47;CT tomograph or a Discovery 690 &#40;General Electric Company&#8212;GE<span class="elsevierStyleSup">&#174;</span>&#8212;Milwaukee&#44; WI&#44; USA&#41; with standard parameters &#40;CT&#58; 80<span class="elsevierStyleHsp" style=""></span>mA&#44; 120<span class="elsevierStyleHsp" style=""></span>kV&#59; 2&#46;5-4<span class="elsevierStyleHsp" style=""></span>min per bed-PET-step of 15<span class="elsevierStyleHsp" style=""></span>cm&#41;&#59; reconstruction was performed with a 128<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>128 matrix and 60<span class="elsevierStyleHsp" style=""></span>cm field of view&#46; Patients were instructed to void before imaging acquisition&#44; no oral or intravenous contrast agents were administrated or bowel preparation used for any patient&#59; written consent was obtained before studies&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The PET images were analyzed visually and semi-quantitatively by measuring the maximum standardized uptake value body weight &#40;SUVmax&#41;&#44; metabolic tumor volume &#40;MTV&#41; and total lesion glycolysis &#40;TLG&#41;&#46; Readers had knowledge of clinical history&#44; and every focal tracer uptake deviating from physiological distribution and background was regarded as suggestive of disease&#59; it was defined as <span class="elsevierStyleSup">18</span>F-FDG activity higher than the surrounding tissue and blood-pool activity on visual analysis&#46; We measured the SUV of detectable lesions by drawing a region of interest &#40;ROI&#41; over the area of maximum activity and the SUVmax was calculated as the highest SUV of the pixels within the ROI&#46; The lesion with the highest <span class="elsevierStyleSup">18</span>F-FDG uptake in each patient was taken as the reference lesion and the SUVmax&#44; was calculated for analysis&#46; MTV was measured from attenuation-corrected <span class="elsevierStyleSup">18</span>F-FDG-PET images using a SUV-based automated contouring program &#40;Advantage Workstation 4&#46;6&#44; GE HealthCare&#41; with an isocounter threshold method based on 41&#37; of the SUVmax&#44; as previously recommended by European Association of Nuclear Medicine because of its high inter-observer reproducibility&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">18</span></a> Total MTV &#40;tMTV&#41; was obtained by the sum of all lesions&#44; local and non local&#46; TLG was calculated as the sum of the product of MTV of each lesion and its SUVmean&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Conventional imaging &#40;CI&#41;&#44; including contrast-enhanced CT if no contraindications and MRI&#44; were used for comparison with <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT scan when available and within an interval of maximum 30 days&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Reference standard</span><p id="par0045" class="elsevierStylePara elsevierViewall">A combination of clinical&#47;imaging follow-up &#40;CT&#44; MRI&#44; ultrasonography and&#47;or PET&#47;CT&#41; for at least 12 months after restaging <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT and&#47;or histopathology &#40;when available&#41; was taken as the reference standard&#46; Because histopathological confirmation of all lesions was not ethically and clinically feasible&#44; histopathology was available only for 50 studies&#46; Lesions demonstrating increase in size on radiologic follow-up examinations and&#47;or increase in <span class="elsevierStyleSup">18</span>F-FDG uptake on subsequent PET&#47;CT were considered as true positive&#59; also lesions showing response to therapy were taken as true positive&#46; Instead&#44; lesions not showing any change or decrease in size and&#47;or <span class="elsevierStyleSup">18</span>F-FDG uptake without any treatment were considered as false positive&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Statistical analysis</span><p id="par0050" class="elsevierStylePara elsevierViewall">All statistical analysis was carried out using Statistical Package for Social Science &#40;SPSS&#41; version 23&#46;0 for Windows &#40;IBM&#44; Chicago&#44; Illinois&#44; USA&#41; and MedCalc Software version 17&#46;1 for Windows &#40;Ostend&#44; Belgium&#41;&#46; A <span class="elsevierStyleItalic">p-</span>value<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 was considered statistically significant&#46; The descriptive analysis of categorical variables comprised the calculation of simple and relative frequencies&#46; The numeric variables were described as mean&#44; minimum and maximum&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Univariate logistic regression analysis was performed to assess the relationship between qualitative <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT &#40;<span class="elsevierStyleSup">18</span>F-FDG avidity&#41; and the other parameters&#46; Variables with <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 in the univariate analysis were further analyzed using multivariate logistic regression analysis to determinate which variables were independently associated&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Using final diagnosis as a reference&#44; sensitivity&#44; specificity&#44; negative predictive value &#40;NPV&#41;&#44; positive predictive value &#40;PPV&#41; and accuracy were calculated based on Bayes&#39;s law&#44; with 95&#37; confidence intervals &#40;CIs&#41;&#46; PFS was determined considering the time interval between restaging PET&#47;CT and the appearance of clinical and&#47;or radiological progression&#46; OS was defined as the time interval between restaging PET&#47;CT and death&#46; PFS and OS were computed using Kaplan&#8211;Meier curves&#46; Univariate and multivariate Cox proportional hazards models were fitted in the whole sample&#46; The relationship between outcome and the variables included was summarized by hazard ratios &#40;HR&#41; with 95&#37; confidence intervals &#40;95&#37; CI&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">For the entire population&#44; receiver operating characteristic &#40;ROC&#41; curve analysis was used to identify the optimal cutoff point of semiquantitative parameters in the light of which interpret the results of progression free survival &#40;PFS&#41; and overall survival &#40;OS&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100"><span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT performance in detecting recurrence</span><p id="par0070" class="elsevierStylePara elsevierViewall">Based on the reference standard mentioned in the Methods section&#44; a definitive diagnosis of recurrent disease at the time of restaging PET&#47;CT was present in 81 patients&#44; whereas there was no recurrent disease in 76 patients&#46; <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT was positive in 79 scans &#40;50&#46;3&#37;&#41; showing the presence of at least one hypermetabolic lesion consistent with EC local recurrence or metastatic lesion&#44; while in the remaining 78 studies &#40;49&#46;7&#37;&#41; no areas of increased <span class="elsevierStyleSup">18</span>F-FDG uptake were discovered&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT sites of recurrence included local pelvic relapse in 9 cases&#44; locoregional lymph nodes in 30 patients&#44; both local recurrence and regional lymph nodes in 9 patients&#59; distant metastatic disease was observed in 18 studies&#44; 8 studies showed both locoregional nodes and metastatic disease and 5 local pelvic relapse and distant metastases together&#46; Lung was the most common site of distant metastasis &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>15&#41;&#44; followed by peritoneum &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#41;&#44; liver and bone &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3 each&#41;&#46; Other rarer sites of metastatic involvement were intestine&#44; brain&#44; or disseminate disease involving different organs &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Suspected recurrence of EC was confirmed in 78&#47;79 patients with a positive <span class="elsevierStyleSup">18</span>F-FDG-PET scan &#40;as reference&#44; other imaging and&#47;or follow-up clinical data were used in 30 patients and histopathology in 49&#41;&#46; In one patient&#44; <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT showed a false positive finding with an increased <span class="elsevierStyleSup">18</span>F-FDG uptake in several iliac nodes&#44; later diagnosed as lymph nodal chronic inflammatory disease&#46; Instead&#44; in 75&#47;78 patients with a negative <span class="elsevierStyleSup">18</span>F-FDG-PET&#44; other imaging and&#47;or follow-up clinical data confirmed the absence of recurrent disease&#46; In three cases PET&#47;CT failed to detect recurrences&#59; in two patients due to the presence of small lung nodular lesions under the spatial resolution of the PET&#47;CT scanner &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41; and in one patient with peritoneal disease PET&#47;CT showed no significant increased <span class="elsevierStyleSup">18</span>F-FDG uptake&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Sensitivity&#44; specificity&#44; positive predictive value&#44; negative predictive value and accuracy of <span class="elsevierStyleSup">18</span>F-FDG-PET&#47;CT were 96&#37;&#44; 99&#37;&#44; 99&#37;&#44; 96&#37; and 97&#37;&#44; respectively&#46; Positive and negative likelihood ratios were 73&#46;19 and 0&#46;04&#44; respectively</p><p id="par0090" class="elsevierStylePara elsevierViewall">Comparing the two groups &#40;patients with positive and negative PET&#47;CT&#41; in terms of age&#44; histotype and primary treatment there were no significant differences &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; Patients with hypermetabolic lesions presented more frequently a high stage according to FIGO classification compared to patients with negative PET&#47;CT scans&#46; This evidence was confirmed both in univariate and multivariate analysis&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">In patients with a positive <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT&#44; average SUVmax of the lesion with higher&#44; FDG uptake was 13&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;7 &#40;range 2&#46;7-33&#41;&#44; MTV 28&#46;35<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>41&#46;6<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">3</span> &#40;1-250&#41; and TLG 230<span class="elsevierStyleHsp" style=""></span>&#177;381 &#40;1&#46;5-2310&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Comparison with CI</span><p id="par0100" class="elsevierStylePara elsevierViewall">Comparative CI &#40;contrast enhanced CT&#44; MRI&#41; was available for 150 PET-CT studies&#58; abdominal MRI in 8 cases and CT in 142 cases&#46; CT was done as segmental examination of chest&#44; abdomen and pelvis&#46; Of these 150 CI examinations&#44; 102 were positive for recurrence and among them&#44; 74 were true positive&#44; whereas 28 were false-positive&#59; the remaining 48 CI studies were negative with 46 true negative scans and 2 false negative&#46; Sensitivity&#44; specificity&#44; positive predictive value&#44; negative predictive value and accuracy of CI were 97&#37;&#44; 62&#37;&#44; 72&#37;&#44; 96&#37;&#44; 80&#37;&#44; respectively&#46; Positive and negative likelihood ratios were 2&#46;57 and 0&#46;04&#44; respectively &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; CI and PET&#47;CT were concordant in 120 patients and discordant in 30 patients&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110"><span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT prognostic role</span><p id="par0105" class="elsevierStylePara elsevierViewall">After a mean follow-up period of 39 months &#40;range 2&#8211;120&#41;&#44; relapse or progression of disease occurred in 58 &#40;37&#37;&#41; patients with an average time of 22&#46;1 months &#40;range&#58; 2-96 months&#41; from the restaging PET&#47;CT and death occurred in 37 &#40;23&#37;&#41; patients with an average time of 27&#46;6 months &#40;range 2-117&#41;&#46; Among the 99 patients without disease progression&#44; 81 were disease-free and 18 had stable disease at the last follow-up control&#46; The estimated 3-year PFS and OS rates were 86&#37; and 71&#37; respectively&#44; while 5-year PFS and OS rates were 67&#37; and 56&#37;&#44; respectively&#46; A positive <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT was significantly associated with shorter PFS and OS compared to unremarkable PET&#47;CT scan&#44; both at 3-years &#40;PFS 37&#37; vs 91&#37; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#59; OS 54&#37; vs 98&#37; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; and at 5-years &#40;PFS 27&#37; vs 77&#37; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#59; OS 40&#37; vs 92&#37; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; In the univariate Cox regression analysis&#44; an unremarkable <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT scan was associated with a significantly longer survival rate &#40;PFS and OS&#41; compared to a positive scan &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46; Similarly&#44; advanced stage disease &#40;III and IV acc&#46; to FIGO&#41;&#44; other than endometriod carcinoma histotype &#40;serous or clear cell carcinoma&#41;&#44; nodal disease and distant metastatic disease correlated with a shorter PFS and OS compared to early stage &#40;I&#44; II&#41;&#44; endometriod carcinoma histotype&#44; the absence of nodal disease and the absence of metastatic disease&#46; However&#44; at multivariate analysis&#44; PET&#47;CT positivity and advanced FIGO stage disease were confirmed as the only variables with independent prognostic value&#46; Instead by evaluating semiquantitative PET&#47;CT parameters in those patients with positive findings &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>79&#41;&#44; SUVmax&#44; MTV and TLG failed to show a significant predictive value both for PFS and OS &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Impact of <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT on therapeutic approach</span><p id="par0110" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT results had a significant impact on the therapeutic approach in 33 patients &#40;21&#37;&#41;&#46; In 28 cases of negative PET&#47;CT and suspected disease at conventional imaging techniques&#44; PET&#47;CT results demonstrated to be true negative and patients remained in &#8220;watch and wait&#8221; approach avoiding unnecessary invasive therapies&#46; On the contrary&#44; in 5 patients with a positive PET&#47;CT scan&#44; the therapeutic regimen was modified switching from local therapy to chemotherapy due to the detection of disseminate disease in comparison with local disease detected at CT&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Discussion</span><p id="par0115" class="elsevierStylePara elsevierViewall">EC is a very common gynecological malignancy that generally presents good prognosis but in patients who develop recurrence outcome is unfavorable&#46; Usually recurrence happens within 2 years of initial treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">2</span></a> Surely&#44; an early and accurate detection of recurrence in patients with EC is expected to have a significant impact on management and survival outcomes&#46; Conventional imaging examinations&#44; like CT and MRI&#44; and biochemical analysis &#40;CA125&#41; have been shown to be useful in demonstrating recurrence&#44; but may have low specificity and may not localize the site of recurrent disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">4&#8211;6</span></a> Considering the poor prognosis of recurrent EC&#44; the identification of a helpful modality to detect recurrence is mandatory&#46; To overcome the limitations of imaging modalities based on morphology&#44; <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT is a molecular imaging technique that can assess the metabolic activity of the tumor&#46; Some studies demonstrated a better diagnostic accuracy of <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT compared to other conventional imaging modalities in restaging EC&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">9&#44;19</span></a> The clinical role of <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT in the management of post-treatment EC patients is relatively less described&#46; Several authors<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">7&#8211;16&#44;19&#8211;21</span></a> have reported high clinical diagnostic accuracy of integrated PET&#47;CT for post-therapy surveillance of patients with EC and suspicious of recurrence&#46; According to literature data&#44; the patient-based pooled sensitivity and specificity of <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT in post-therapy surveillance of EC were 96&#37; &#40;range 87&#37;&#8211;100&#37;&#41; and 93&#37; &#40;range 79&#37;&#8211;100&#37;&#41;&#44; respectively &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#41;&#46; In our study&#44; the results were comparable to the literature&#59; we demonstrated that <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT performed in the restaging process has optimal diagnostic performances and is higher than conventional imaging&#46; In fact&#44; the sensitivity and specificity in our study were 96&#37; and 99&#37; respectively&#44; while diagnostic accuracy was 97&#37;&#46; Ryu et al&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">7</span></a> evaluated the role of PET alone in 127 asymptomatic post therapy patients showing a sensitivity of 100&#37; and a specificity of 88&#37;&#46; Also Saga et al&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">9</span></a> in their study found PET to be highly sensitive &#40;100&#37;&#41; and specific &#40;88&#46;2&#37;&#41; for detecting recurrence&#46; Kitajima et al&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">13</span></a> found PET alone to be inferior to PET&#47;CT&#44; with lower sensitivity &#40;80&#37; vs&#46; 93&#37;&#41;&#44; specificity &#40;80&#37; vs&#46; 93&#37;&#41;&#44; and diagnostic accuracy &#40;80&#37; vs&#46; 93&#37;&#41; in detecting recurrence&#46; Recently Sharma et al&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">19</span></a> demonstrated good sensitivity and specificity but lower compared to our results&#46; Moreover&#44; they compared PET&#47;CT and CI diagnostic accuracy in restaging patients with suspicion of recurrence and they discovered higher specificity and accuracy but comparable sensitivity&#46; Also in our work&#44; we demonstrated a superior detection rate of PET&#47;CT compared to CI in specificity and accuracy &#40;99&#37; vs 62&#37;&#44; 97&#37; vs 80&#37;&#41; and similar sensitivity &#40;96&#37; vs 97&#37;&#41;&#46; Verification by surgical exploration or imaging-guided biopsy of superficial lymph nodes&#44; liver&#44; lung or other distant metastases was performed if available&#46; Otherwise&#44; the results of PET&#47;CT were confirmed by clinical or radiologic outcomes&#44; particularly in patients with disseminated disease&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">In this study&#44; we demonstrated that positive <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT and advanced stage disease were the only independent prognostic factors of outcome&#44; both for PFS and OS&#46; There is a strong relation between advanced stage and the probability of a positive restaging PET&#47;CT&#58; patients with FIGO stage III or IV had more frequently PET&#47;CT positive for recurrence&#46; Other studied demonstrated significant prognostic value of PET&#47;CT in EC in the staging process&#44; before any treatment&#44;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">22&#8211;32</span></a> showing a significant role of PET&#47;CT features&#44; especially SUVmax and MTV value&#44; in the prediction of outcome survival&#46; In this regard&#44; to the best of our knowledge&#44; this is the first paper investigating the prognostic role of <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT in restaging patients affected by EC&#46; Instead&#44; SUVmax did not correlated with PFS and OS using a cutoff of 3&#46;8 &#40;derived by ROC curve analysis&#41;&#46; This evidence was in opposition to several articles that demonstrated the positive role of SUVmax at staging in predicting prognosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">23&#8211;26</span></a> Only Chung et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">14</span></a> in a small sample of EC patients&#44; showed that the 2-year PFS rate of patients with a negative PET&#47;CT scan for recurrence was significantly better than for patients with a positive PET&#47;CT &#40;100&#37; vs 33&#46;7&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;015&#41;&#46; In their study&#44; all patients with negative PET&#47;CT scans were still alive without evidence of disease at the last follow-up control&#59; however&#44; among patients with positive PET&#47;CT scans 10&#47;13 had progression of disease or relapse&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">In our work&#44; the mean SUVmax of the recurrent lesions was 13&#46;1 &#40;range 2&#46;7&#8211;33&#41;&#44; similar to that documented by Chao et al&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">19</span></a> and higher than other studies&#44;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">8</span></a> possibly due to the higher number of patients and scans evaluated and the homogenous distribution of their clinico-pathological features&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">In our study MTV and TLG did not demonstrate prognostic features in recurrent EC&#46; These parameters include both morphological and metabolic features and may be considered an expression of tumor aggressiveness together with tumor size characteristic&#44; but their role is not completely understood and many open questions stay&#46; Different methods are available and a wide range of threshold levels have been proposed to calculate the volume-based PET&#47;CT parameters without univocal consensus&#46; Moreover&#44; there are no published technical references about the methodology for the calculation of the volume based PET parameters and definition of specific cutoff values in endometrial cancer&#46; Several studies<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">29&#8211;32</span></a> demonstrated the prognostic role of MTV and TLG in survival outcome of EC but these parameters were calculated at pretreatment PET&#47;CT&#59; no previous papers about possible prognostic role of MTV and TLG at restaging were done&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Moreover&#44; our results confirm the possible role of PET&#47;CT to change patient&#39;s management and therapeutic approach in a significant rate of patient &#40;about 20&#37;&#41;&#59; in fact in 33 patients&#44; <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT had a positive impact avoiding unnecessary therapies in 28 cases and changing the therapeutic approach in 5 patients&#46; Other authors<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">9&#44;10&#44;15&#44;16</span></a> confirmed this result underlying the potential usefulness of PET&#47;CT in the management of EC&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Based on the findings of this paper&#44; <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT seems to be an accurate method for detection and localization of local and distant recurrences in patients with EC showing good sensitivity and specificity and a significant impact on the clinical decision-making&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">The limitations of our study are the retrospective nature of the study design&#44; the use of two different PET&#47;CT devices and the absence of histological confirmation of all findings &#40;the most reliable method but not ethically or clinically feasible&#41;&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conclusions</span><p id="par0150" class="elsevierStylePara elsevierViewall">In conclusion&#44; in our study we demonstrated that <span class="elsevierStyleSup">18</span>FDG PET&#47;CT was a highly sensitive and specific modality for detecting recurrence in post-therapy patients of endometrial carcinoma with suspected recurrence and had a significant clinical impact changing the therapeutic approach&#46; PET&#47;CT diagnostic accuracy seemed to be better than CI&#46; Furthermore&#44; PET&#47;CT results and FIGO stage were significantly correlated with outcome survival&#44; both for PFS and OS&#44; while SUVmax&#44; MTV and TLG were not related to outcome survival&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflict of interest</span><p id="par0155" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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          "titulo" => "Introduction"
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              "identificador" => "sec0015"
              "titulo" => "Patients"
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              "titulo" => "F-FDG PET&#47;CT imaging and interpretation"
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              "titulo" => "Reference standard"
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              "titulo" => "F-FDG PET&#47;CT performance in detecting recurrence"
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              "titulo" => "Comparison with CI"
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              "titulo" => "F-FDG PET&#47;CT prognostic role"
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              "titulo" => "Impact of F-FDG PET&#47;CT on therapeutic approach"
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    "fechaRecibido" => "2018-08-07"
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            0 => "Endometrial carcinoma"
            1 => "PET&#47;CT"
            2 => "Endometrium"
            3 => "<span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT"
            4 => "Recurrence"
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          "palabras" => array:5 [
            0 => "Carcinoma de endometrio"
            1 => "PET&#47;TC"
            2 => "Endometrio"
            3 => "<span class="elsevierStyleSup">18</span>F-FDG PET&#47;TC"
            4 => "Recurrencia"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Purpose</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Endometrial carcinoma &#40;EC&#41; is a cancer with a good overall prognosis&#44; except in cases of recurrent or advanced EC&#46; The aim of this study was to assess the diagnostic performance&#44; the prognostic value and the impact on therapeutic management of <span class="elsevierStyleSup">18</span>F-FDG-PET&#47;CT in suspected recurrent EC&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materials and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We retrospectively evaluated 157 patients with histologically proven EC and restaging <span class="elsevierStyleSup">18</span>F-FDG-PET&#47;CT for suspected recurrence&#46; The PET images were analyzed visually and semi-quantitatively by measuring SUVmax&#44; MTV and TLG&#46; A combination of clinical&#47;imaging follow-up and&#47;or histopathology was taken as reference standard&#46; PFS and OS were computed using Kaplan&#8211;Meier curves&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Seventy-nine patients had positive <span class="elsevierStyleSup">18</span>F-FDG-PET&#47;CT showing the presence of at least one hypermetabolic lesion consistent with recurrence&#44; while the remaining 78 were negative&#46; Sensitivity&#44; specificity&#44; positive predictive value&#44; negative predictive value and accuracy of <span class="elsevierStyleSup">18</span>F-FDG-PET&#47;CT were 96&#37;&#44; 99&#37;&#44; 99&#37;&#44; 96&#37;&#44; 97&#37; respectively and were higher compared to conventional imaging&#58; 97&#37;&#44; 62&#37;&#44; 72&#37;&#44; 96&#37;&#44; 80&#37;&#46; After a mean follow-up of 39 months&#44; relapse&#47;progression occurred in 58 patients and death in 37 with an average time of 22&#46;1 and 27&#46;6 months respectively&#46; A positive <span class="elsevierStyleSup">18</span>F-FDG-PET&#47;CT and advanced FIGO stage were significantly associated with shorter PFS and OS&#46; PET&#47;CT results had a significant impact on therapeutic approach in 33 patients&#58; avoiding unnecessary therapies in 28 and modifying therapy in 5&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">18</span>F-FDG-PET&#47;CT has a very good diagnostic performance in patients with suspected recurrent EC and has an important prognostic value in assessing PFS and OS&#46; Moreover&#44; PET&#47;CT allowed for a change in treatment decision in about 20&#37; of cases&#46;</p></span>"
        "secciones" => array:4 [
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            "titulo" => "Materials and methods"
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          2 => array:2 [
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El carcinoma endometrial &#40;CE&#41; es un c&#225;ncer con un buen pron&#243;stico general&#44; excepto en los casos de CE recurrente o avanzado&#46; El objetivo de este estudio fue evaluar el rendimiento diagn&#243;stico&#44; y pron&#243;stico y el impacto en el manejo terap&#233;utico de la PET&#47;TC con <span class="elsevierStyleSup">18</span>F-FDG en la sospecha de CE recurrente&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se evaluaron retrospectivamente 157 pacientes con CE histol&#243;gicamente probado y reestadificaci&#243;n de PET&#47;TC con <span class="elsevierStyleSup">18</span>F-FDG por sospecha de recurrencia&#46; Las im&#225;genes PET se analizaron visualmente y semicuantitativamente midiendo SUVmax&#44; MTV y TLG&#46; Se tom&#243; como referencia una combinaci&#243;n de seguimiento cl&#237;nico&#47;radiol&#243;gico&#47;histopatol&#243;gico&#46; PFS y OS se calcularon usando las curvas de Kaplan-Meier&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Setenta y nueve pacientes tuvieron una PET&#47;TC con <span class="elsevierStyleSup">18</span>F-FDG positiva que mostr&#243; la presencia de al menos una lesi&#243;n hipermetab&#243;lica compatible con recurrencia&#44; mientras que los 78 restantes fueron negativos&#46; La sensibilidad&#44; especificidad&#44; valor predictivo positivo&#44; valor predictivo negativo y precisi&#243;n de la PET&#47;TC con <span class="elsevierStyleSup">18</span>F-FDG fueron 96&#37;&#44; 99&#37;&#44; 99&#37;&#44; 96&#37;&#44; 97&#37; respectivamente y fueron m&#225;s altos en comparaci&#243;n con las im&#225;genes convencionales&#58; 97&#37;&#44; 62&#37;&#44; 72&#37;&#44; 96&#37;&#44; 80&#37;&#46; Despu&#233;s de un seguimiento medio de 39 meses&#44; la reca&#237;da&#47;progresi&#243;n ocurri&#243; en 58 pacientes y la muerte en 37 con un tiempo promedio de 22&#44;1 y 27&#44;6 meses respectivamente&#46; Una PET&#47;TC con <span class="elsevierStyleSup">18</span>F-FDG positiva y un estadio FIGO avanzado se asociaron significativamente con un PFS y OS m&#225;s cortos&#46; Los resultados de PET&#47;TC tuvieron un impacto significativo en el abordaje terap&#233;utico en 33 pacientes&#58; evitando terapias innecesarias en 28 y modificando la terapia en 5&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La <span class="elsevierStyleSup">18</span>F-FDG-PET&#47;TC tiene un muy buen rendimiento diagn&#243;stico en pacientes con sospecha de recurrente CE&#44; y tiene un importante valor pron&#243;stico en la evaluaci&#243;n de SLP y SG&#46; Adem&#225;s&#44; la PET&#47;TC permiti&#243; un cambio en la decisi&#243;n de tratamiento en aproximadamente el 20&#37; de los casos&#46;</p></span>"
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            "titulo" => "Material y m&#233;todos"
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            "titulo" => "Resultados"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Please cite this article as&#58; Albano D&#44; Zizioli V&#44; Odicino F&#44; Giubbini R&#44; Bertagna F&#46; Valor cl&#237;nico y pron&#243;stico de la PET&#47;TC con <span class="elsevierStyleSup">18</span>F-FDG en el c&#225;ncer de endometrio recurrente&#46; Rev Esp Med Nucl Imagen Mol&#46; 2019&#59;38&#58;87&#8211;93&#46;</p>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">A representative case of a positive <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT in a 64-year old woman with increased CA-125 marker and endometroid carcinoma previously treated with surgery plus RTT&#46; Maximum intensity projection &#40;MIP&#44; a&#41; showing the presence of multiple FDG uptake foci&#46; Axial PET and PET&#47;CT images demonstrating hypermetabolic lesions in the liver &#40;b&#44; c&#41;&#44; in the bone corresponding to sternum and vertebra &#40;d&#44; e&#41; and in the left lung &#40;f&#44; g&#41;&#46;</p>"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">A representative case of a false negative <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT in a 59-year old patient with endometroid carcinoma who underwent restaging <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT for suspected relapse&#46; MIP &#40;a&#41; detecting no increased FDG uptake&#46; Axial PET &#40;b&#44; d&#41; and PET&#47;CT fused &#40;c&#44; e&#41; images showing the presence of pulmonary nodules with no significant FDG increased uptake&#46;</p>"
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                  <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="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\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">Frequency&nbsp;\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">&#37;&nbsp;\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"><span class="elsevierStyleItalic">Age average &#40;range&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">61&#46;8 &#40;31&#8211;84&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\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="elsevierStyleItalic">Primary FIGO stage</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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&nbsp;\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&nbsp;\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&nbsp;\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\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" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Histotype</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>Endometrioid adenocarcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">125&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&nbsp;\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 carcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\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 carcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\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" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Treatment</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>Surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&nbsp;\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>Surgery<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>chemotherapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\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>Surgery<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>radiotherapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&nbsp;\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>Surgery<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>radiotherapy<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>chemotherapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&nbsp;\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" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleSup"><span class="elsevierStyleItalic">18</span></span><span class="elsevierStyleItalic">F-FDG PET&#47;CT result</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>Positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&#46;3&nbsp;\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>Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Baseline characteristics of 157 patients&#46;</p>"
        ]
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        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
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          0 => array:3 [
            "identificador" => "at2"
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">AUC&#58;</span> area under curve&#59; <span class="elsevierStyleItalic">CI</span>&#58; confidence interval&#59; <span class="elsevierStyleItalic">sens&#58;</span> sensibility&#59; <span class="elsevierStyleItalic">spec&#58;</span> specificity&#59; <span class="elsevierStyleItalic">SUV&#58;</span> standardized uptake value&#59; <span class="elsevierStyleItalic">tMTV&#58;</span> total metabolic tumor volume&#59; <span class="elsevierStyleItalic">TLG&#58;</span> total lesion glycolysis&#46;</p>"
          "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">Parameter&nbsp;\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">Cutoff&nbsp;\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">AUC &#40;95&#37; CI&#41;&nbsp;\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">p</span> value&nbsp;\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">Sens &#40;95&#37; CI&#41;&nbsp;\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">Spec &#40;95&#37; CI&#41;&nbsp;\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">SUVmax&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;570 &#40;0&#46;453-0&#46;682&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;328&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&#37; &#40;92&#46;2-100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#37; &#40;11&#46;5-43&#46;3&#41;&nbsp;\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">tMTV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;524 &#40;0&#46;408-0&#46;637&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;721&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">76&#46;6&#37; &#40;62-87&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&#46;6&#37; &#40;23&#46;7-59&#46;3&#41;&nbsp;\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">TLG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">139&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;498 &#40;0&#46;384-0&#46;613&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;980&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66&#37; &#40;50&#46;7-79&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47 &#40;29&#46;1-65&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Metabolic PET&#47;CT parameters cutoff calculated using receiver operating characteristic &#40;ROC&#41; curve analysis considering the entire population&#46;</p>"
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      5 => array:8 [
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        "etiqueta" => "Table 3"
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            "detalle" => "Table "
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        "tabla" => array:2 [
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              "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="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">PET&#47;CT detection rate</th><th class="td" title="table-head  " align="left" valign="top" scope="col"><span class="elsevierStyleItalic">p</span> value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\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">Positive &#40;&#37;&#41;&#44; <span class="elsevierStyleItalic">n</span> 79&nbsp;\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">Negative &#40;&#37;&#41;&#44; <span class="elsevierStyleItalic">n</span> 78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\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"><span class="elsevierStyleItalic">Age average</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">63&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">60&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;090&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" 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"><span class="elsevierStyleItalic">Stage FIGO</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;030<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> &#40;0&#46;018&#41;&nbsp;\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>I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23 &#40;29&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35 &#40;46&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17 &#40;22&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 &#40;15&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32 &#40;40&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30 &#40;38&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" 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"><span class="elsevierStyleItalic">Histotype</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;052&nbsp;\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">58 &#40;73&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">67 &#40;86&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\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 carcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 &#40;13&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\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 carcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 &#40;14&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" 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"><span class="elsevierStyleItalic">Primary treatment</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;208&nbsp;\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>Surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23 &#40;29&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17 &#40;22&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\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>Surgery<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>CMT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 &#40;20&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 &#40;20&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\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>Surgery<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>RTT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32 &#40;41&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28 &#40;36&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\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>Surgery<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>CMT<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>RTT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;10&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17 &#40;22&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  <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-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Univariate PFS</th><th class="td" title="table-head  " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Multivariate PFS</th><th class="td" title="table-head  " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Univariate OS</th><th class="td" title="table-head  " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Multivariate OS</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\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">p</span> value&nbsp;\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">HR &#40;95&#37; IC&#41;&nbsp;\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">p</span> value&nbsp;\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">HR &#40;95&#37; IC&#41;&nbsp;\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">p</span> value&nbsp;\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">HR &#40;95&#37; IC&#41;&nbsp;\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">p</span> value&nbsp;\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">HR &#40;95&#37; IC&#41;&nbsp;\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">Stage III&#8211;IV &#40;FIGO&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;527 &#40;0&#46;30&#8211;0&#46;86&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;949 &#40;1&#46;11&#8211;3&#46;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;333 &#40;0&#46;16&#8211;0&#46;62&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;632 &#40;1&#46;67&#8211;7&#46;89&#41;&nbsp;\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">Not endometrioid carcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;026&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;022 &#40;0&#46;21&#8211;0&#46;90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;465&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;263 &#40;0&#46;67&#8211;2&#46;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;021&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;450 &#40;0&#46;14&#8211;0&#46;85&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;633&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;201 &#40;0&#46;56&#8211;2&#46;54&#41;&nbsp;\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">Lymph-nodal disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;320 &#40;0&#46;12&#8211;0&#46;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;309&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;439 &#40;0&#46;71&#8211;2&#46;89&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;273 &#40;0&#46;08&#8211;0&#46;39&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;071&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;242 &#40;0&#46;93&#8211;5&#46;37&#41;&nbsp;\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">Distant metastases&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;350 &#40;0&#46;12&#8211;0&#46;48&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;269&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;450 &#40;0&#46;75&#8211;2&#46;79&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;314 &#40;0&#46;08&#8211;0&#46;46&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;070&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;164 &#40;0&#46;94&#8211;4&#46;97&#41;&nbsp;\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">PET&#47;CT pos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;159 &#40;0&#46;10&#8211;0&#46;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;414 &#40;1&#46;82&#8211;10&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;080 &#40;0&#46;08&#8211;0&#46;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;847 &#40;1&#46;40&#8211;24&#46;2&#41;&nbsp;\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">SUVmax<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>3&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;073&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;000 &#40;0&#46;09&#8211;1&#46;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;172&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;000 &#40;0&#46;07&#8211;1&#46;59&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\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">MTV<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>6&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;217&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;660 &#40;0&#46;36&#8211;1&#46;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;370&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;702 &#40;0&#46;33&#8211;1&#46;49&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\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">TLG<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>139&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;706&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;12 &#40;0&#46;61&#8211;2&#46;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;247&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;674 &#40;0&#46;31&#8211;1&#46;34&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \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">Author&nbsp;\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">Year&nbsp;\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">No&#46; pts&nbsp;\t\t\t\t\t\t\n
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                  \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">Belhocine&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PET&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">96&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">78&#37;&nbsp;\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">Saga&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PET&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&#37;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">88&#37;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PET&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">55 &#40;median&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">87&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">97&#37;&nbsp;\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">Sironi&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PET&#47;CT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">61&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&#37;&nbsp;\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">Kitajima&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PET&#47;CT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">93&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">93&#37;&nbsp;\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">Park&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PET&#47;CT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83&#37;&nbsp;\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">Chung&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PET&#47;CT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">95&#37;&nbsp;\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">Kitajima&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PET&#47;CT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50 &#40;median&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">92&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">97&#37;&nbsp;\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">Ryu&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">127&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PET&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">52 &#40;median&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">88&#37;&nbsp;\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">Ozcan kara&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PET&#47;CT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">96&#37;&nbsp;\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">Sharma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">101&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PET&#47;CT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">56&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">89&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">94&#37;&nbsp;\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">Our study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">157&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PET&#47;CT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">96&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">99&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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Article information
ISSN: 22538089
Original language: English
DOI:10.1016/j.remnie.2018.10.004
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