{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T06:29:19Z","timestamp":1777530559159,"version":"3.51.4"},"reference-count":62,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2021,9,6]],"date-time":"2021-09-06T00:00:00Z","timestamp":1630886400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>The purpose of this study is to review the clinical characteristics, treatment modalities, and potential contributing and prognostic factors of bone metastases from gynecological cancers (GCs). A systematic literature search on PubMed, Scopus, Web of Science Core Collection and Cochrane Central Register of Controlled Trials databases was conducted. Thirty-one studies, all retrospective, were included in this review, for a total of 2880 patients with GC bone metastases. Primary tumors leading to bone metastases included endometrial cancer (EC), cervical cancer (CC), ovarian cancer (OC), uterine sarcoma (US) and vulvar cancer (VuC), mainly with an International Federation of Gynecology and Obstetrics (FIGO) Stage of III and IV. The main bone metastatic lesion site was the vertebral column, followed by the pelvic bone and lower extremity bones. The median survival rate after bone metastases diagnosis ranged from 3.0 to 45 months. The most frequent treatments were palliative and included radiotherapy and chemotherapy, followed by surgery. The findings of this review give a first dataset for a greater understanding of GC bone metastases that could help clinicians move toward a more \u201cpersonalized\u201d and thus more effective patient management.<\/jats:p>","DOI":"10.3390\/diagnostics11091626","type":"journal-article","created":{"date-parts":[[2021,9,6]],"date-time":"2021-09-06T10:59:12Z","timestamp":1630925952000},"page":"1626","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Clinical Characteristics, Treatment Modalities, and Potential Contributing and Prognostic Factors in Patients with Bone Metastases from Gynecological Cancers: A Systematic Review"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7402-4054","authenticated-orcid":false,"given":"Francesca","family":"Salamanna","sequence":"first","affiliation":[{"name":"Complex Structure Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3140-4772","authenticated-orcid":false,"given":"Anna Myriam","family":"Perrone","sequence":"additional","affiliation":[{"name":"Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy"},{"name":"Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40126 Bologna, Italy"},{"name":"Centro di Studio e Ricerca delle Neoplasie Ginecologiche (CSR), University of Bologna, 40138 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deyanira","family":"Contartese","sequence":"additional","affiliation":[{"name":"Complex Structure Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Veronica","family":"Borsari","sequence":"additional","affiliation":[{"name":"Complex Structure Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandro","family":"Gasbarrini","sequence":"additional","affiliation":[{"name":"Department of Oncologic and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Silvia","family":"Terzi","sequence":"additional","affiliation":[{"name":"Department of Oncologic and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pierandrea","family":"De Iaco","sequence":"additional","affiliation":[{"name":"Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy"},{"name":"Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40126 Bologna, Italy"},{"name":"Centro di Studio e Ricerca delle Neoplasie Ginecologiche (CSR), University of Bologna, 40138 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Milena","family":"Fini","sequence":"additional","affiliation":[{"name":"Complex Structure Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,9,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"iii124","DOI":"10.1093\/annonc\/mdu103","article-title":"Bone health in cancer patients: ESMO Clinical Practice Guidelines","volume":"25","author":"Coleman","year":"2014","journal-title":"Ann. Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1016\/j.ygyno.2018.09.002","article-title":"Quality indicators in gynecologic oncology","volume":"151","author":"Dowdy","year":"2018","journal-title":"Gynecol. Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"277","DOI":"10.3322\/caac.20073","article-title":"Cancer statistics, 2010","volume":"60","author":"Jemal","year":"2010","journal-title":"CA Cancer J. Clin."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1016\/j.ejca.2009.12.014","article-title":"Estimates of cancer incidence and mortality in Europe in 2008","volume":"46","author":"Ferlay","year":"2010","journal-title":"Eur. J. Cancer"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1016\/j.ygyno.2010.01.047","article-title":"Clinicopathologic features of bone metastases and outcomes in patients with primary endometrial cancer","volume":"117","author":"Kehoe","year":"2010","journal-title":"Gynecol. Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1006\/gyno.2000.6058","article-title":"Hematogenous dissemination in corpus cancer","volume":"80","author":"Mariani","year":"2001","journal-title":"Gynecol. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.2353\/ajpath.2010.100105","article-title":"Ovarian cancer development and metastasis","volume":"177","author":"Lengyel","year":"2010","journal-title":"Am. J. Pathol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1111\/IGC.0b013e3181d4a0a1","article-title":"Bone metastasis in cervical cancer patients over a 10-year period","volume":"20","author":"Thanapprapasr","year":"2010","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1136\/ijgc-00009577-200303000-00004","article-title":"Distant metastases in ovarian carcinoma","volume":"13","author":"Cormio","year":"2003","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1006\/gyno.1996.4511","article-title":"Predictors of distant recurrence in clinical stage I or II endometrial carcinoma treated by combination surgical and radiation therapy","volume":"64","author":"Descamps","year":"1997","journal-title":"Gynecol. Oncol."},{"key":"ref_11","first-page":"49","article-title":"Vulvar cancer with bone metastases: A rare case report","volume":"5","author":"Ghosh","year":"2013","journal-title":"IJCRR"},{"key":"ref_12","first-page":"643","article-title":"Efficacy of operative treatment for pathological fractures in bone metastases in relation to length and comfort of survival","volume":"65","author":"Dutka","year":"2000","journal-title":"Chir. Narzadow Ruchu Ortop. Pol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"7515","DOI":"10.2147\/CMAR.S268075","article-title":"Clinical Characteristics and Prognostic Analysis of Gynecologic Cancer with Spinal Metastases: A Single-Center Retrospective Study","volume":"12","author":"Liu","year":"2020","journal-title":"Cancer Manag. Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2099","DOI":"10.1002\/jbmr.3618","article-title":"Understanding the Bone in Cancer Metastasis","volume":"33","author":"Fornetti","year":"2018","journal-title":"J. Bone Miner Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2849","DOI":"10.1097\/01.brs.0000245838.37817.40","article-title":"Impact of surgical intervention on quality of life in patients with spinal metastases","volume":"31","author":"Falicov","year":"2006","journal-title":"Spine"},{"key":"ref_16","unstructured":"(2021, May 28). Study Quality Assessment Tools, Available online: https:\/\/www.nhlbi.nih.gov\/health-topics\/study-quality-assessment-tools."},{"key":"ref_17","unstructured":"(2021, August 20). Available online: https:\/\/oem.bmj.com\u203ainline-supplementary-material-2."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1016\/j.ygyno.2018.06.022","article-title":"Sites of distant metastases and overall survival in ovarian cancer: A study of 1481 patients","volume":"150","author":"Deng","year":"2018","journal-title":"Gynecol. Oncol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"3024","DOI":"10.1093\/annonc\/mdt398","article-title":"Prognostic role of early versus late onset of bone metastasis in patients with carcinoma of the ovary, peritoneum and fallopian tube","volume":"24","author":"Sehouli","year":"2013","journal-title":"Ann. Oncol."},{"key":"ref_20","first-page":"1270","article-title":"Bone metastasis from ovarian cancer. Clinical analysis of 26 cases","volume":"34","author":"Zhang","year":"2013","journal-title":"Saudi Med. J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"3133","DOI":"10.7150\/jca.30335","article-title":"The prevalence, associated factors for bone metastases development and prognosis in newly diagnosed ovarian cancer: A large population based real-world study","volume":"10","author":"Zhang","year":"2019","journal-title":"J. Cancer"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1533033820945784","DOI":"10.1177\/1533033820945784","article-title":"The Clinical Characteristics of Endometrial Cancer With Extraperitoneal Metastasis and the Value of Surgery in Treatment","volume":"19","author":"Guo","year":"2020","journal-title":"Technol. Cancer Res. Treat"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"100698","DOI":"10.1016\/j.gore.2021.100698","article-title":"Detection of bone metastases in uterine cancer: How common are they and should PET\/CT be the standard for diagnosis?","volume":"35","author":"Hong","year":"2021","journal-title":"Gynecol. Oncol. Rep."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1111\/jog.12960","article-title":"Bone recurrence rarely seen in endometrial cancer and review of the literature","volume":"42","author":"Kimyon","year":"2016","journal-title":"J. Obstet. Gynaecol. Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1002\/jso.26102","article-title":"Prognostic value of different metastatic sites for patients with FIGO stage IVB endometrial cancer after surgery: A SEER database analysis","volume":"122","author":"Li","year":"2020","journal-title":"J. Surg. Oncol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1002\/ijgo.13084","article-title":"Prognostic value of distant metastatic sites in stage IV endometrial cancer: A SEER database study of 2948 women","volume":"149","author":"Liu","year":"2020","journal-title":"Int. J. Gynaecol. Obstet."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"525","DOI":"10.2217\/fon-2020-0017","article-title":"Clinicopathological study of organ metastasis in endometrial cancer","volume":"16","author":"Mao","year":"2020","journal-title":"Future Oncol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"100549","DOI":"10.1016\/j.gore.2020.100549","article-title":"A clinicopathologic study of endometrial cancer metastatic to bone: Identification of microsatellite instability improves treatment strategies","volume":"32","author":"McEachron","year":"2020","journal-title":"Gynecol. Oncol. Rep."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1016\/j.ejso.2019.01.011","article-title":"Incidence, patterns and prognosis of first distant recurrence after surgically treated early stage endometrial cancer: Results from the multicentre FRANCOGYN study group","volume":"45","author":"Ouldamer","year":"2019","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1093\/jjco\/hyw120","article-title":"A prediction model of survival for patients with bone metastasis from uterine corpus cancer","volume":"46","author":"Takeshita","year":"2016","journal-title":"Jpn. J. Clin. Oncol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1016\/j.ygyno.2013.05.010","article-title":"Bone metastases in endometrial cancer: Report on 19 patients and review of the medical literature","volume":"130","author":"Uccella","year":"2013","journal-title":"Gynecol. Oncol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1097\/IGC.0000000000000015","article-title":"Bone metastasis in primary endometrial carcinoma: Features, outcomes, and predictors","volume":"24","author":"Yoon","year":"2014","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1097\/PGP.0000000000000284","article-title":"Distant Metastases in Uterine Leiomyosarcomas: The Wide Variety of Body Sites and Time Intervals to Metastatic Relapse","volume":"36","author":"Bartosch","year":"2017","journal-title":"Int. J. Gynecol. Pathol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"306","DOI":"10.3802\/jgo.2014.25.4.306","article-title":"Metastatic pattern of uterine leiomyosarcoma: Retrospective analysis of the predictors and outcome in 113 patients","volume":"25","author":"Tirumani","year":"2014","journal-title":"J. Gynecol. Oncol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1016\/j.ygyno.2016.07.009","article-title":"Patterns of distant metastases in vulvar cancer","volume":"142","author":"Prieske","year":"2016","journal-title":"Gynecol. Oncol."},{"key":"ref_36","first-page":"290","article-title":"Prognostic factors for survival in cervical cancer patients with bone metastasis","volume":"36","author":"Kanayama","year":"2015","journal-title":"Eur. J. Gynaecol. Oncol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.1097\/IGC.0000000000001273","article-title":"Management of Vertebral Metastasis in Patients With Uterine Cervical Cancer","volume":"28","author":"Kocaer","year":"2018","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1136\/ijgc-2018-000108","article-title":"Detection of distant metastatic disease by positron emission tomography with 18 F-fluorodeoxyglucose (FDG-PET) at initial staging of cervical carcinoma","volume":"29","author":"Lin","year":"2019","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1111\/jog.12956","article-title":"Treatment and prognosis of bone metastasis from cervical cancer (KCOG-G1202s)","volume":"42","author":"Makino","year":"2016","journal-title":"J. Obstet. Gynaecol. Res."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1097\/COC.0000000000000439","article-title":"Emphasis on Systemic Therapy in Women with Pelvic Bone Metastasis at Time of Diagnosis of Cervical Cancer","volume":"41","author":"Manders","year":"2018","journal-title":"Am. J. Clin. Oncol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e55","DOI":"10.3802\/jgo.2016.27.e55","article-title":"A prediction model of survival for patients with bone metastasis from uterine cervical cancer","volume":"27","author":"Matsumiya","year":"2016","journal-title":"J. Gynecol. Oncol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"8401","DOI":"10.7314\/APJCP.2014.15.19.8401","article-title":"Age and survival of cervical cancer patients with bone metastasis","volume":"15","author":"Nartthanarung","year":"2014","journal-title":"Asian Pac. J. Cancer Prev."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1260","DOI":"10.4103\/jcrt.JCRT_374_18","article-title":"Nodal metastasis of cervix carcinoma- As a probable cause of bone erosion","volume":"15","author":"Sethi","year":"2019","journal-title":"J. Cancer Res. Ther."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1186\/s13014-019-1297-x","article-title":"Efficacy of radical doses of pelvic radiotherapy for primary tumor treatment in patients with newly diagnosed organ metastatic cervical cancer","volume":"14","author":"Yin","year":"2019","journal-title":"Radiat. Oncol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1311","DOI":"10.1097\/IGC.0b013e31829da127","article-title":"Contributing factors for bone metastasis in uterine cervical cancer","volume":"23","author":"Yoon","year":"2013","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"6387","DOI":"10.12659\/MSM.912071","article-title":"Real-World Study of the Incidence, Risk Factors, and Prognostic Factors Associated with Bone Metastases in Women with Uterine Cervical Cancer Using Surveillance, Epidemiology, and End Results (SEER) Data Analysis","volume":"24","author":"Zhang","year":"2018","journal-title":"Med. Sci. Monit."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1532","DOI":"10.7150\/jca.37390","article-title":"Prognosis for different patterns of distant metastases in patients with uterine cervical cancer: A population-based analysis","volume":"11","author":"Zhang","year":"2020","journal-title":"J. Cancer"},{"key":"ref_48","first-page":"1615","article-title":"Patterns of metastases in cervical cancer: A population-based study","volume":"13","author":"Zhou","year":"2020","journal-title":"Int. J. Clin. Exp. Pathol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1543","DOI":"10.1016\/S0002-9440(10)63412-8","article-title":"Heterogeneity in primary and metastatic prostate cancer as defined by cell surface CD profile","volume":"165","author":"Liu","year":"2004","journal-title":"Am. J. Pathol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1007\/978-1-4419-9129-4_13","article-title":"Histological, immunophenotypic and histomorphometric characterization of prostate cancer bone metastases","volume":"118","author":"Roudier","year":"2004","journal-title":"Cancer Treat Res."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1038\/s41572-020-00216-3","article-title":"Bone metastases","volume":"6","author":"Coleman","year":"2020","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1038\/sj.cr.7290266","article-title":"Mechanisms of cancer metastasis to the bone","volume":"15","author":"Yin","year":"2005","journal-title":"Cell Res."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1314","DOI":"10.21037\/apm.2019.08.07","article-title":"Role of bone-modifying agents in advanced cancer","volume":"9","author":"Desautels","year":"2020","journal-title":"Ann. Palliat. Med."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1016\/j.ygyno.2017.08.002","article-title":"The effect of a multidisciplinary palliative care initiative on the end of life care in gynecologic oncology patients","volume":"147","author":"Mullen","year":"2017","journal-title":"Gynecol. Oncol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1016\/j.ygyno.2013.06.012","article-title":"Palliative and hospice care in gynecologic cancer: A review","volume":"131","author":"Lowery","year":"2013","journal-title":"Gynecol. Oncol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1186\/s13046-019-1494-3","article-title":"MicroRNA-338-3p suppresses ovarian cancer cells growth and metastasis: Implication of Wnt\/catenin beta and MEK\/ERK signaling pathways","volume":"38","author":"Zhang","year":"2019","journal-title":"J. Exp. Clin. Cancer Res."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"152452","DOI":"10.1016\/j.prp.2019.152452","article-title":"DAAM1-mediated migration and invasion of ovarian cancer cells are suppressed by miR-208a-5p","volume":"215","author":"Mei","year":"2019","journal-title":"Pathol. Res. Pract."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1007\/s00404-019-05107-x","article-title":"Downregulation of miR-4443 and miR-5195-3p in ovarian cancer tissue contributes to metastasis and tumorigenesis","volume":"299","author":"Ebrahimi","year":"2019","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Cohen, P.A., Flowers, N., Tong, S., Hannan, N., Pertile, M.D., and Hui, L. (2016). Abnormal plasma DNA profiles in early ovarian cancer using a non-invasive prenatal testing platform: Implications for cancer screening. BMC Med., 14.","DOI":"10.1186\/s12916-016-0667-6"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"2223","DOI":"10.1158\/1078-0432.CCR-16-1078","article-title":"Chromosomal Instability in Cell-Free DNA as a Highly Specific Biomarker for Detection of Ovarian Cancer in Women with Adnexal Masses","volume":"23","author":"Vanderstichele","year":"2017","journal-title":"Clin. Cancer Res."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"29831","DOI":"10.1038\/srep29831","article-title":"Quantification of Somatic Chromosomal Rearrangements in Circulating Cell-Free DNA from Ovarian Cancers","volume":"6","author":"Harris","year":"2016","journal-title":"Sci. Rep."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"A5","DOI":"10.1016\/j.jclinepi.2021.04.008","article-title":"PRISMA 2020","volume":"134","author":"Tugwell","year":"2021","journal-title":"J. Clin. Epidemiol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/11\/9\/1626\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:57:35Z","timestamp":1760165855000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/11\/9\/1626"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,6]]},"references-count":62,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2021,9]]}},"alternative-id":["diagnostics11091626"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics11091626","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,6]]}}}