A M García Vicente

Hospital General Universitario de Ciudad Real, Ciudad Real, Castille-La Mancha, Spain

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Publications (107)95.31 Total impact

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    ABSTRACT: To explore the relationship between basal (18) F-FDG PET/CT information in breast tumours and survival in locally advanced breast cancer (LABC). This prospective, multicentre study included 198 women diagnosed with LABC. All patients underwent (18) F-FDG PET/CT prior to treatment. The maximum standardized uptake value (SUVmax) in tumor (T), lymph nodes (N) and the N/T ratio was obtained in all cases. Stage according to PET/CT imaging (metabolic stage) and conventional imaging techniques (clinical stage) was established. During follow-up, patient status was established (disease free status or not). The relationship between all the variables and overall survival (OS) and disease-free survival (DFS) was analysed using the Kaplan-Meier and Cox regression methods. A ROC analysis was performed to obtain a cut-off value of SUVmax that was useful in the prediction of outcome. The mean SUVmax ± SD values in the primary tumour, lymph nodes and the SUVmax N/T index were 7.40 ± 5.57, 4.17 ± 4.74 and 0.73 ± 1.20, respectively. Higher semiquantitative metabolic values were found in more advanced metabolic and clinical stages. During follow-up, 78.4 % of patients were free of disease. Significant relationships were observed between SUVT and SUVN and patient status. With respect to OS and DFS, significant differences were detected for the metabolic stage. Kaplan-Meier analysis revealed that using the cut-off values, a primary-tumour SUVmax ≥ 6.05 or a nodal SUVmax ≥2.25 were significantly correlated with DFS and OS. PET imaging with (18) F-FDG offers prognostic information for LABC that can be obtained preoperatively and noninvasively.
    European Journal of Nuclear Medicine 07/2015; DOI:10.1007/s00259-015-3102-x · 5.38 Impact Factor
  • Revista Española de Medicina Nuclear e Imagen Molecular 06/2015; 34(3). DOI:10.1016/j.remnie.2014.12.030 · 0.86 Impact Factor
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    ABSTRACT: To compare the diagnostic performance of different metabolical, morphological and clinical criteria for correct presurgical classification of the solitary pulmonary nodule (SPN). Fifty-five patients, with SPN were retrospectively analyzed. All patients underwent preoperative (18)F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT). Maximum diameter in CT, maximum standard uptake value (SUVmax), histopathologic result, age, smoking history and gender were obtained. Different criteria were established to classify a SPN as malignant: (I) visually detectable metabolism, (II) SUVmax >2.5 regardless of SPN diameter, (III) SUVmax threshold depending of SPN diameter, and (IV) ratio SUVmax/diameter greater than 1. For each criterion, statistical diagnostic parameters were obtained. Receiver operating characteristic (ROC) analysis was performed to select the best diagnostic SUVmax and SUVmax/diameter cutoff. Additionally, a predictive model of malignancy of the SPN was derived by multivariate logistic regression. Fifteen SPN (27.3%) were benign and 40 (72.7%) malignant. The mean values ± standard deviation (SD) of SPN diameter and SUVmax were 1.93±0.57 cm and 3.93±2.67 respectively. Sensitivity (Se) and specificity (Sp) of the different diagnostic criteria were (I): 97.5% and 13.1%; (II) 67.5% and 53.3%; (III) 70% and 53.3%; and (IV) 85% and 33.3%, respectively. The SUVmax cut-off value with the best diagnostic performance was 1.95 (Se: 80%; Sp: 53.3%). The predictive model had a Se of 87.5% and Sp of 46.7%. The SUVmax was independent variables to predict malignancy. The assessment by semiquantitative methods did not improve the Se of visual analysis. The limited Sp was independent on the method used. However, the predictive model combining SUVmax and age was the best diagnostic approach.
    06/2015; 4(3):228-35. DOI:10.3978/j.issn.2218-6751.2015.05.07
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    ABSTRACT: (99m)Tc-tetrofosmin single photon emission computed tomography ((99m)Tc-tetrofosmin SPECT) has an important role in the assessment of coronary artery disease. Despite being its main indication, this study does not only evaluate myocardial perfusion, but much more. Moreover, during the SPECT acquisition, the field area covered includes many important organs of the thorax and abdomen, so extracardiac abnormalities can be observed. The correct etiologic diagnosis of them is only possible if we understand how (99m)Tc-tetrofosmin works and make a comprehensive investigation of the clinical history of the patient. Copyright © 2015 Elsevier España, S.L.U. and SEMNIM. All rights reserved.
    Revista Española de Medicina Nuclear e Imagen Molecular 05/2015; DOI:10.1016/j.remn.2015.03.005 · 0.86 Impact Factor
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    ABSTRACT: This study aimed to determine the diagnostic impact of (18)F-FDG PET/CT based on the clinical features of paraneoplastic neurological syndrome (PNS). Multicenter retrospective and longitudinal study of patients with suspicion of PNS. The clinical picture was classified into classic (CS) and non-classic syndrome (NCS). After the follow-up, the definitive or possible diagnosis of PNS was established. The pictures that did not match any of the previous criteria were categorized as non-classifiable. The state of the onco-neural antibodies was studied. The PET/CT was classified as positive or negative for the detection of malignancy. The relationship between PET/CT findings and the final diagnosis was determined. The differences between variables (Pearson test X(2)) and the relationship between the results of the PET/CT and the final diagnosis were analyzed. A total of 64 patients were analyzed, classifying 30% as CS and 42% as NCS. After the follow-up, 20% and 16% of subjects were diagnosed as possible and definitive PNS, respectively. Positive onco-neural antibodies were found in 13% of the patients. A definitive diagnosis of PNS was associated with a positive PET/CT (P=.08). A significant relation between antibodies expression and final diagnosis of neoplasia (P=.04) was demonstrated. The PET/CT correctly localized malignancy in 5/7 cases of invasive cancer. The PET/CT showed a higher percentage of positive results in patients with definitive diagnosis of PNS. Despite the low prevalence of malignancy in our series, the PET/CT detected malignancy in a significant proportion of patients with invasive cancer. Copyright © 2014 Elsevier España, S.L.U. y SEMNIM. All rights reserved.
    04/2015; 34(4). DOI:10.1016/j.remn.2015.02.006
  • Revista Española de Medicina Nuclear e Imagen Molecular 01/2015; 34(3). DOI:10.1016/j.remn.2014.12.006 · 0.86 Impact Factor
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    ABSTRACT: The aim of our work was to determine the accuracy of 99mTc--HYNIC Tyr3 Octreotide scintigraphy (TcOS) in detecting active disease in neuroendocrine tumors (NETs) based on embryological origin of the primary tumor (foregut, midgut or hind gut). We analyzed retrospectively 45 studies (12 staging, 26 suspicion of recurrence, and 7 treatment response) belonging to 33 patients with histological confirmation of NETs. Whole body scan and a SPECT--CT were acquired 4 hours post--injection of 740 MBq of 99mTc-- HYNIC Tyr3 Octreotide. The studies were divided into 3 groups based on the embryological origin of primary tumor [foregut (group 1), midgut (group 2) and hindgut (group 3)]. The accuracy of TcOS in each group was assessed, included chi--square analyses. The final diagnosis was established by histopathology or clinical/radiological follow--up greater than 6 months. The localization of the primary tumor per patient revealed that 58% were from the foregut, 30% from the midgut and 12% from the hindgut. In study based analysis (45 studies), TcOS showed an overall sensitivity, specificity and accuracy of 95%, 92% and 93% respectively. The accuracy per studies for the group 1, 2 and 3 were: 100%, 92% and 66% respectively, demonstrating a better detection of active disease in primary tumors from foregut and midgut compared to hindgut (p: 0.02). The accuracy of TcOS in the assessment of NETs seems to be better in tumors with foregut and midgut origin, showing a possible relationship between the embryological origin of NETs and detection of active disease by TcOS.
    Minerva endocrinologica 01/2015; · 1.32 Impact Factor
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    ABSTRACT: Objective This study evaluated the usefulness of 18F-fluorocholine PET/CT in restaging patients with a history of prostate adenocarcinoma who faced biochemical relapse after early radical treatment, and correlated the technique's disease detection rate with a set of variables and clinical and pathological parameters.Material and methodsThis was a retrospective multicentre study which included 374 patients referred for choline PET/CT who had biochemical relapse. In the end, 233 patients who met the following inclusion criteria were analysed: diagnosis of prostate cancer; early radical treatment; biochemical relapse; main clinical and pathological variables; and clinical, pathological and imaging data needed to validate the results. Criteria used to validate the PET/CT: findings from other imaging techniques, clinical follow-up, treatment response and histological analysis. Different statistical tests were used depending on the distribution of the data to correlate the results of the choline PET/CT with qualitative (T, N, early prostatectomy vs. other treatments, hormone therapy concomitant to choline PET/CT) and quantitative (age, Gleason score, PSA levels at diagnosis, PSA nadir, PSA on the day of the choline PET/CT or trigger PSA and PSADT) variables. We analysed whether there were independent predictive factors associated with the positive PET/CT result. All statistical tests were considered two-sided and significant values where p<0.05.ResultsThe choline PET/CT was positive in 111 of 233 patients (detection rate: 47.6%) and negative in 122 (52.4%). Disease locations: prostate or prostate bed in 26 patients (23.4%); regional and/or distant lymph nodes in 52 (46.8%); and metastatic bone disease in 33 (29.7%). Positive findings were validated by: results from other imaging techniques in 35 patients (15.0%); at least 6 months of clinical follow-up in 136 (58.4%); treatment response in 24 (10.3%); histological analysis of lesions in 17 (7.3%); and follow-up plus imaging results in 21 (9.0%). The statistical analysis of qualitative variables, corresponding to patients′ clinical characteristics, and the positive/negative final PET/CT results revealed that only whether or not early treatment with radical prostatectomy was done was statistically significant (p<0.001), with the number of positive results higher in patients who did not undergo a radical prostatectomy. Among the quantitative variables, Gleason score, trigger PSA and PSADT clearly differentiated the two patient groups (positive and negative choline PET/CT): p=0.010, p=0.001 and p=0.025, respectively. A Gleason score of <5 or ≥8 clearly differentiated positive from negative PET. Trigger PSA: mean of 8 ngr/ml for positive PET/CT vs. 2.8 for negative PET/CT; PSADT: mean of 8 months for positive PSADT and 12.6 for negative PSADT. The optimal cut-off points were: 3 ngr/ml for trigger PSA and 6 months for PSADT (Youden index/ROC curve). Analysing these two variables together showed that PSADT was more conclusive in patients with lower PSA Trigger. Analysing variables by location showed that only PSADT was able to differentiate between those with disease confined to the prostate compared with the other two locations (lymph nodes and bone), with shorter PSADT in these two, which was statistically significant (p<0.002). In the patient group with PSA of <1.5 ngr/ml, 30.8% had the disease, 7% of whom had metastatic bone disease. In the multivariate logistic regression, the risks factors that were clearly independent for those with positive PET/CT were: PSA >3 ngr/ml; no early prostatectomy; and Gleason score of ≥8.Conclusion Our results support the usefulness of 18F-fluorocholine PET/CT in biochemical relapse of prostate cancer after radical treatment, with an overall disease detection rate close to 50%, and it can be recommended as first-line treatment. As mentioned above, besides PSA levels on the day of the PET/CT, there are other clinical and pathological variables to consider in order to screen patients properly and thus minimise the number of nodular lesions and increase the diagnostic accuracy of the exam.
    BJU International 10/2014; 115(6). DOI:10.1111/bju.12953 · 3.13 Impact Factor
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    ABSTRACT: Objective To assess the accuracy of FDG-PET/contrast enhanced CT (FDG-PET/ceCT) in the detection of unsuspected recurrence of colorectal cancer (CRC) in patients with high risk of relapse. Methods Thirty-three patients (14 females and 19 males, mean age: 62, range: 41-78), with CRC in complete remission, were prospectively included. All patients underwent FDG-PET/ceCT (58 studies). FDG-PET/ceCT was requested in the surveillance setting, and performed following a standardized protocol. A portal venous phase CT scan was performed after the injection of iodinated contrast agent. An individual and combined assessment of both techniques (PET and ceCT) was performed. Concordant and discordant findings of PET, ceCT and FDG-PET/ceCT were compared in a patient-based and a lesion-based analysis. The final diagnosis, recurrence or disease free status (DFS), were established by histopathology or clinical/radiological follow-up of at least 6 months. Results Seven out of 33 patients had a confirmed recurrence and the rest of patients had a DFS. In a patient-based analysis the sensitivity and specificity of PET, ceCT and PET/ceCT was of 86% and 88%, 86% and 92%, 86% and 85%, respectively. Attending to the lesion-based analysis, the sensitivity for PET, ceCT and PET/ceCT was of 56%, 71% and 97% respectively. Both techniques showed a good concordance in the establishment of the final patient status. However, on a lesion-based analysis, no concordance was observed between them. Conclusion PET and ceCT seem to have similar value in the detection of unsuspected recurrence of CRC in a patient-based analysis. However, the combined assessment of PET/ceCT improves the accuracy in the lesion-based analysis.
    European Journal of Radiology 09/2014; 83(12). DOI:10.1016/j.ejrad.2014.08.016 · 2.16 Impact Factor
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    ABSTRACT: To investigate the relationships between tumor heterogeneity, assessed by texture analysis of [18F]fluorodeoxyglucose-positron emission tomography (FDG-PET) images, metabolic parameters, and pathologic staging in patients with non-small cell lung carcinoma (NSCLC). A retrospective analysis of 38 patients with histologically confirmed NSCLC who underwent staging FDG-PET/computed tomography was performed. Tumor images were segmented using a standardized uptake value (SUV) cutoff of 2.5. Five textural features, related to the heterogeneity of gray-level distribution, were computed (energy, entropy, contrast, homogeneity, and correlation). Additionally, metabolic parameters such as SUVmax, SUVmean, metabolic tumor volume (MTV), and total lesion glycolysis (TLG), as well as pathologic staging, histologic subtype, and tumor diameter, were obtained. Finally, a correlation analysis was carried out. Of 38 tumors, 63.2% were epidermoid and 36.8% were adenocarcinomas. The mean ± standard deviation values of MTV and TLG were 30.47 ± 25.17 mL and 197.81 ± 251.11 g, respectively. There was a positive relationship of all metabolic parameters (SUVmax, SUVmean, MTV, and TLG) with entropy, correlation, and homogeneity and a negative relationship with energy and contrast. The T component of the pathologic TNM staging (pT) was similarly correlated with these textural parameters. Textural features associated with tumor heterogeneity were shown to be related to global metabolic parameters and pathologic staging.
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    ABSTRACT: The purpose of the present study is to explore the relation between glycolytic metabolism assessed by (18)F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) and final neoadjuvant chemotherapy (NC) response in locally advanced breast tumors. Of women with breast cancer, 126 were prospectively evaluated. All patients underwent (18)F-FDG PET/CT previous to NC. Standard uptake value (SUV) max was calculated in the primary tumor. After NC, residual primary tumor specimen was histopathologically classified according to Miller and Payne tumor regression grades (TRG), from G1 to G5 and in response groups as good responders (G4 or G5), partial responders (G2 or G3), and non-responders (G1). Furthermore, residual lesions were classified following a binary assessment as responders (G4 or G5) and non-responders (the rest of cases). The relationship between SUV max with TRG and response groups was evaluated. Of tumors, 127 were assessed (a patient had bilateral breast lesions). TRG were as follows: G1 (27), G2 (27), G3 (32), G4 (11), and G5 (30). Forty-one were classified as good responders, 59 as partial responders, and 27 as non-responders. For the binary assessment, 41 lesions were classified as responders and 86 as non-responders. We found statistical differences (p = 0.02) between the mean SUV max and TRG with greater SUV values for G5 compared to the other TRG. Good responders showed greater mean SUV max ± SD compared to partial responders and non-responders (10.51 ± 6.64 for good responders, 6.94 ± 5.81 for partial responders, and 5.23 ± 2.76 for non-responders; p = 0.001). Baseline tumor metabolism assessing by FDG PET/CT was associated with the final histopathologic status after neoadjuvant chemotherapy, with greater SUV max values for good responders compared to the less responder cancers.
    Tumor Biology 08/2014; 35(11). DOI:10.1007/s13277-014-2495-7 · 3.61 Impact Factor
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    ABSTRACT: Aim. To compare the performance of six different nomograms and one score in the prediction of non-sentinel lymph node status in a subset of women with breast cancer and micrometastatic sentinel nodes (SN). Material and methods. Twenty-five patients were included in the study. Five different nomograms not specifically designed for micrometastatic SN, one recently published nomogram specially developed for this type of patients and one score were analyzed, and the corresponding receiver operating characteristic curves were obtained. The area under the curve (AUC) was calculated, as well as the false negative and false positive results and their corresponding rates (FNR and FPR) for a cutoff of ≤10% or ≤4 points. Results. The Memorial Sloan Kettering Cancer Center (MSKCC) nomogram showed the best performance in this low-risk group of patients (AUC 0.900, FPR 64%, FNR 0%), followed by the French nomogram. Conclusions. The MSKCC nomogram seems to have the highest accuracy in the identification of patients with low risk of further axillary disease in the subgroup of women with micrometastatic SN.
    Tumori 07/2014; 100(4):415-9. DOI:10.1700/1636.17898 · 1.09 Impact Factor
  • Interactive Cardiovascular and Thoracic Surgery 06/2014; 18(suppl 1):S42-S42. DOI:10.1093/icvts/ivu167.159 · 1.11 Impact Factor
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    ABSTRACT: To determine the utility of (18)F-FDG (FDG) PET/CT performed in an early and delayed phase during neoadjuvant chemotherapy in the prediction of lymph node histopathological response in patients with locally advanced breast cancer. FDG PET/CT studies performed in 76 patients (mean age 53 years) at baseline (PET-1), after the second course of chemotherapy (PET-2) and after the last course of chemotherapy (PET-3) were prospectively analysed. Inclusion criteria were lymph node involvement detected by PET/CT and non-sentinel node biopsy before or after the baseline PET/CT scan. Following the recommendations of the 12th International Breast Conference (St. Gallen), the patients were divided into five subgroups in relation to biological prognostic factors by immunohistochemistry. For diagnosis visual and semiquantitative analyses was performed. Absence of detectable lymph node uptake on the PET-2 or PET-3 scan with respect to the PET-1 scan was considered metabolic complete response (mCR). Lymph nodes were histopathologically classified according the lymph node regression grade and in response groups as pathological complete response (pCR) or not pCR (type A/D or B/C of the Smith grading system, respectively). ROC analysis was performed to determine a cut-off value of Δ% SUV1-2 and SUV1-3 for prediction of nodal status after chemotherapy. An association between mCR and pCR was found (Cohen's kappa analysis), and associations between phenotypes and metabolic behaviour and the final histopathological status were also found. Lymph node pCR was seen in 34 patients. The sensitivity, specificity, and positive and negative predictive values of PET-2 and PET-3 in establishing the final status of the axilla after chemotherapy were 52 %, 45 %, 50 % and 47 %, and 33 %, 84 %, 67 % and 56 %, respectively. No significant relationship was observed between mCR on PET-2 and PET-3 and pCR (p = 0.31 and 0.99, respectively). Lymph node metabolism on PET-1 was not able to predict the final histopathological status, whereas basal carcinomas showed a higher rate of pCR (70.6 %) than the other groups (p = 0.03). FDG PET/CT seems to have limitations in both the early and delayed evaluation of lymph node status after chemotherapy, with reduced predictive values.
    European Journal of Nuclear Medicine 04/2014; 41(7). DOI:10.1007/s00259-013-2657-7 · 5.38 Impact Factor
  • A.M. García Vicente · J.M. Cordero García · Á. Soriano Castrejón
    01/2014; 33(1):60–61. DOI:10.1016/j.remn.2013.06.002
  • A M García Vicente · J M Cordero García · A Soriano Castrejón
    08/2013; 33(1). DOI:10.1016/j.remnie.2013.11.006
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    ABSTRACT: AIM: To assess dual time point 2-deoxy-2-[(18)F]fluoro-d-glucose (18)(F)FDG PET-CT accuracy in nodal staging and in detection of extra-axillary involvement. MATERIAL AND METHODS: Dual time point [(18)F] FDG PET/CT scan was performed in 75 patients. Visual and semiquantitative assessment of lymph nodes was performed. Semiquantitative measurement of SUV and ROC-analysis were carried out to calculate SUVmax cut-off value with the best diagnostic performance. Axillary and extra-axillary lymph node chains were evaluated. RESULTS: Sensitivity and specificity of visual assessment was 87.3% and 75%, respectively. SUVmax values with the best sensitivity were 0.90 and 0.95 for early and delayed PET, respectively. SUVmax values with the best specificity were 1.95 and 2.75, respectively. Extra-axillary lymph node involvement was detected in 26.7%. CONCLUSION: FDG PET/CT detected extra-axillary lymph node involvement in one-fourth of the patients. Semiquantitative lymph node analysis did not show any advantage over the visual evaluation.
    05/2013; 33(1). DOI:10.1016/j.remn.2013.03.005
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    ABSTRACT: PURPOSE: To determine whether the metabolic features of breast tumours differ among molecular subtypes. METHODS: This prospective study included 168 women diagnosed with locally advanced breast cancer. PET/CT was requested in the initial staging before neoadjuvant treatment (multicentre study, FISCAM grant). All patients underwent an (18)F-FDG PET/CT scan with a dual time-point acquisition. Both examinations (PET-1 and PET-2) were evaluated qualitatively and semiquantitatively with calculation of SUVmax (SUV-1 and SUV-2, respectively), and the percentage variation in the SUVs and retention indexes (RI) between PET-1 and PET-2 in the breast tumour were calculated. Biological prognostic parameters, including the steroid receptor status, HER-2 expression, proliferation rate (Ki-67) and grading, were determined from primary tumour tissue. Tumour subtypes were classified following the recommendations of the 12th International Breast Conference, by immunohistochemical surrogates as luminal A, luminal B-HER2(-), luminal B-HER2(+), HER2(+) or basal. Metabolic semiquantitative parameters and molecular subtypes were correlated. RESULTS: Of the 168 tumours, 151 were classified: 16 were luminal A, 53 were luminal B-HER2(-), 29 were luminal B-HER2(+), 18 were HER2(+) and 35 were basal. There were significant differences between SUV-1 and SUV-2 and the different subtypes, with higher SUVs in HER2(+) and basal tumours. No significant differences were found with respect to RI. CONCLUSION: Semiquantitative metabolic parameters showed statistically significant differences among the molecular subtypes of the tumours evaluated. Therefore, there seems to be a relationship between molecular and glycolytic phenotypes.
    European Journal of Nuclear Medicine 04/2013; 40(9). DOI:10.1007/s00259-013-2418-7 · 5.38 Impact Factor
  • 04/2013; 32(5). DOI:10.1016/j.remn.2013.02.006
  • Medecine Nucleaire 03/2013; 37(3):64. DOI:10.1016/j.mednuc.2013.02.004 · 0.16 Impact Factor