Article
Revista Española de Medicina Nuclear e Imagen Molecular (English Edition)
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Avanzando por buen camino" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "1" "paginaFinal" => "2" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "PET/CT in uterine tumors. Progressing on the right direction" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A.P. Caresia Aróztegui, L. Ribot Luna" "autores" => array:2 [ 0 => array:2 [ "nombre" => "A.P." "apellidos" => "Caresia Aróztegui" ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Ribot Luna" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2253808918301186" "doi" => "10.1016/j.remnie.2018.11.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808918301186?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253654X18302890?idApp=UINPBA00004N" "url" => "/2253654X/0000003800000001/v1_201901110626/S2253654X18302890/v1_201901110626/es/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S2253808918300582" "issn" => "22538089" "doi" => "10.1016/j.remnie.2018.07.005" "estado" => "S300" "fechaPublicacion" => "2019-01-01" "aid" => "1004" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Esp Med Nucl Imagen Mol. 2019;38:3-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Prognostic role of FDG PET-derived parameters in preoperative staging of endometrial cancer" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "3" "paginaFinal" => "9" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Función pronóstica de los parámetros derivados de FDG PET en la estadificación preoperatoria del cáncer de endometrio" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1509 "Ancho" => 1508 "Tamanyo" => 77165 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Disease free survival curves according to TLG-50<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>77.58 (black line) or ≥77.58 (red line; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.0472).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "P. Mapelli, A. Bergamini, F. Fallanca, P.M.V. Rancoita, R. Cioffi, E. Incerti, E. Rabaiotti, M. Petrone, G. Mangili, M. Candiani, L. Gianolli, M. Picchio" "autores" => array:12 [ 0 => array:2 [ "nombre" => "P." "apellidos" => "Mapelli" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Bergamini" ] 2 => array:2 [ "nombre" => "F." "apellidos" => "Fallanca" ] 3 => array:2 [ "nombre" => "P.M.V." "apellidos" => "Rancoita" ] 4 => array:2 [ "nombre" => "R." "apellidos" => "Cioffi" ] 5 => array:2 [ "nombre" => "E." "apellidos" => "Incerti" ] 6 => array:2 [ "nombre" => "E." "apellidos" => "Rabaiotti" ] 7 => array:2 [ "nombre" => "M." "apellidos" => "Petrone" ] 8 => array:2 [ "nombre" => "G." "apellidos" => "Mangili" ] 9 => array:2 [ "nombre" => "M." "apellidos" => "Candiani" ] 10 => array:2 [ "nombre" => "L." "apellidos" => "Gianolli" ] 11 => array:2 [ "nombre" => "M." "apellidos" => "Picchio" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S2253654X18300957" "doi" => "10.1016/j.remn.2018.06.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253654X18300957?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808918300582?idApp=UINPBA00004N" "url" => "/22538089/0000003800000001/v1_201901110618/S2253808918300582/v1_201901110618/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "PET/CT in uterine tumors. Progressing on the right direction" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "1" "paginaFinal" => "2" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Ana Paula Caresia-Aróztegui, Laia Ribot-Luna" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Ana Paula" "apellidos" => "Caresia-Aróztegui" "email" => array:1 [ 0 => "paulacaresia@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Laia" "apellidos" => "Ribot-Luna" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Presidenta del Grupo de trabajo Oncología de la SEMNIM, Servicio de Medicina Nuclear, UDIAT, Hospital de Sabadell, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Coordinadora de la Unidad de Ginecología Oncológica, Servicio de Ginecología, Hospital de Sabadell, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "PET/TC en tumores uterinos. Avanzando por buen camino" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Gynecological cancers are infrequent tumors. Taking into account the world population of women, cervical cancer is in fourth place with an incidence of 6.6%, endometrial cancer is in sixth place with 4.4% and ovarian cancer is eighth with 3.4%. These values are well below those of other neoplasms such as the breast which has an incidence of 24.2%, colorectal cancer with 9.5% or lung cancer with an incidence of 8.4%.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">To the contrary, in Spain, endometrial cancer is in fourth place with an incidence of 5.9% and ovarian cancer is ninth with 3%, while cervical cancer is in fifteenth place with 1.7%.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Uterine tumors affecting the upper two thirds of the uterus are essentially endometrial cancer and uterine sarcoma, with cervical cancer being localized in the lower third. These diseases present essential diffferences not only in origin but also in their dissemination, treatment and prognosis.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">3–5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">There are two fundamental types of endometrial neoplasms. Type I which includes endometrioid adenocarcinoma and the mucinous type, which are usually diagnosed early and are related to a good prognosis. On the other hand, type II covers high-grade tumors such as serous adenocarcinoma and clear cell carcinoma, which are more aggressive neoplasms that are usually diagnosed in advanced stages and have a greater tendency to develop recurrence. A worse prognosis in these patients systematically conditions the intensification of the treatment and follow-up.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">5</span></a> On the other hand, the new molecular classification will probably help to better select the patients with the highest risk and to join diagnostic and therapeutic efforts.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Uterine sarcoma is an infrequent tumor which represents less than 10% of uterine neoplasms. It originates in the myometrium or the connective tissue of the uterine corpus. In contrast to the remaining gynecological tumors, the tumor, lymph node, metastasis (TNM) classification is used. Uterine sarcomas comprise leiomyosarcoma and undifferentiated sarcoma which are aggressive tumors with a tendency to distant dissemination and a bad prognosis.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Squamous type cervical cancer is the most frequent. Infection by the high-risk human papillomavirus (HPV) is essential to develop the disease. In Spain, systematic vaccination against HPV is considered the most effective intervention to control the infection. On the other hand, screening is fundamental to detect the disease in an early phase.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">4</span></a> With these manuevers the current incidence of HPV infection in Spain is low. Most patients with cervical cancer are diagnosed in women in developing countries with limited access to diagnostic imaging techniques. This fact has led the International Federation of Gynecology and Obstetrics (FIGO) to consider that initial staging of this tumor should be based on physical examination by an experienced gynecologist. However, once the invasor cancer has developed, the prognosis is directly related to the lymph node stage at diagnosis, despite this information not being included in the FIGO classification.<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">4,7</span></a> Locally advanced tumors are treated with a combination of chemotherapy and radiotherapy. It is important to determine paraaortic lymph node involvement to establish whether the radiotherapy field should be extended.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">7</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In countries with resources, magnetic resonance imaging (MRI) plays a fundamental role in the initial staging of locally advanced uterine tumors. In the case of endometrial cancer, this technique is important to detect invasion of the myometrium. In cervical cancer, MRI helps to evaluate parametrial involvement and infiltration of neighboring organs. MRI also provides information on pelvic lymph node involvement since it is the usual field of study. On the other hand, computed tomography (CT) or <span class="elsevierStyleSup">18</span>F-fluoroxyglucose (FDG) positron emission tomography (PET)/CT is used to detect abdominal-pelvic adenopathies and distant disease, which are relevant data for decision making related to treatment.<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">7,8</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In the last 10 years there has been a radical change in the recommendations of the use of diagnostic imaging techniques in gynecological tumors. We have seen how <span class="elsevierStyleSup">18</span>F-FDG PET/CT which initially appeared in the clinical guidelines of the principal scientific societies only as an optional technique in recurrence of ovarian cancers, has currently become a usual technique in gynecological cancers. There are several keys to this expansion of <span class="elsevierStyleSup">18</span>F-FDG PET/CT in oncologic gynecology, and the greater availability of the technique is one of these keys. One aspect to highlight is that most gynecological tumors have surgery as the primary treatment and this fact has been crucial to successfully validate the diagnostic efficacy of <span class="elsevierStyleSup">18</span>F-FDG PET/CT. The excellent diagnostic yield of this technique in the diagnosis of distant metastasis, which allows unnecessary surgeries to be avoided, has also influenced the wider use of this technique. Consequently, <span class="elsevierStyleSup">18</span>F-FDG PET/CT is achieving an increasingly more relevant role in the individualization and therapeutic decision making of functional units of oncological gynecology.</p><p id="par0045" class="elsevierStylePara elsevierViewall">As mentioned in the article on Continuing Education in this issue,<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">9</span></a> one relevant point is that <span class="elsevierStyleSup">18</span>F-FDG PET/CT is now recognized by the National Comprehensive Cancer Network (NCCN) as a preferential option for the initial staging and radiotherapy planning in locally advanced cervical cancer.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">7</span></a> There is robust scientific evidence that defends this technique as having greater sensitivity and a positive predictive value compared with CT and MRI for the detection of lymph node disease. Nonetheless, <span class="elsevierStyleSup">18</span>F-FDG PET/CT has a false positive rate of 6–15%, which currently does not allow paraaortic lymph node dissection to be avoided in the majority of cases.<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">10,11</span></a> In relation to locally advanced cervical cancer, we are pending the results of the prospective clinical trial (LILACS) which is comparing the design of radiotherapy treatment based on the study of extension by <span class="elsevierStyleSup">18</span>F-FDG PET/CT with the performance of paraaortic lymph node dissection. We hope that the results will provide light on whether lymph node dissection can be avoided, or to the contrary, there are significant differences in the survival of patients when it is carried out.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">12</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">With regard to endometrial cancer, <span class="elsevierStyleSup">18</span>F-FDG PET/CT appears in the principal guidelines of action as an optional technique in locally advanced tumors or in the case of clinical suspicion or by imaging of adenopathies or distant disease, as well as in patients with recurrence who are candidates to surgery or to locoregional treatment with radiotherapy.<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">5,8,13</span></a> In the management of relapse it is fundamental to diagnose the number and exact localization of recurrence, since this can influence both the choice of treatment and can even condition the type of surgical access. In uterine sarcoma, the guidelines propose the use of <span class="elsevierStyleSup">18</span>F-FDG PET/CT as optional in staging if there is suspicion of metastasis.<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">8,14</span></a> The review and metaanalysis published Sadeghi and cols. and the study by Albano and cols. demonstrate that the accuracy of <span class="elsevierStyleSup">18</span>F-FDG PET/CT in the detection of recurrence in uterine sarcomas is excellent, and as such the NCCN supports it use in this context.<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">15,16</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">As described by Baizán and cols. in an editorial in this journal, PET is a molecular imaging modality which can quantitatively characterize the physiological activity of a wide spectrum of underlying biochemical mechanisms in tumoral tissues. There is a large number of recent publications which analyze the quantitative parameters derived from <span class="elsevierStyleSup">18</span>F-FDG PET/CT including both metabolic tumor volume (MTV) and metabolically active tumor load (total lesion glycolysis [TLG]) by segmentation as well as other parameters obtained by the analysis of texture which demonstrates the metabolic heterogenicity of the tumors. These new parameters can clinically evaluate tumor aggressiveness and are of prognostic value in the evolution of the patients.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">17</span></a> In this issue we have two studies which explore the prognostic value of TLG and MTV in endometrial cancer and cervical cancer.<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">18,19</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Looking to the future we will witness the development and availability of semiautomatic systems and even artificial intelligence which can obtain a larger amount of data on the radiomics of tumors. The real clinical application of these tumoral metabolic parameters could contribute to treatment planning and the evolution of patients. We will probably enjoy reading new publications with data on the applicability of PET/MRI in gynecological tumors since both cervical and locally advanced endometrial cancer are good candidates for this technique.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Aróztegui AP, Luna LR. PET/TC en tumores uterinos. Avanzando por buen camino. 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The Revista Española de Medicina Nuclear e Imagen Molecular (Spanish Journal of Nuclear Medicine and Molecular Imaging), was founded in 1982, and is the official journal of the Spanish Society of Nuclear Medicine and Molecular Imaging, which has more than 700 members. The Journal, which publishes 6 regular issues per year, has the promotion of research and continuing education in all fields of Nuclear Medicine as its main aim. For this, its principal sections are Originals, Clinical Notes, Images of Interest, and Special Collaboration articles. The works may be submitted in Spanish or English and are subjected to a peer review process. In 2009, it became the leading Spanish journal in the field of Medical Imaging on having an Impact Factor , awarded by the Journal Citation Reports.
Science Citation Index Expander, Medline, IME, Bibliomed, EMBASE/Excerpta Medica, Healthstar, Cancerlit, Toxine, Inside Conferences, Scopus
See moreThe Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two preceding years.
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SRJ is a prestige metric based on the idea that not all citations are the same. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal's impact.
See moreSNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field.
See moreRevista Española de Medicina Nuclear e Imagen Molecular (English Edition)
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