DaPeCa‐7: comparative assessment of fluorodeoxyglucose positron emission tomography/computed tomography (CT) and conventional diagnostic CT in diagnosis of lymph node metastases, distant metastases and incidental findings in patients with invasive penile cancer

Abstract

Objectives To evaluate diagnostic accuracy of 18F‐fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) compared to contrast‐enhanced CT in assessment of inguinal lymph node (ILN) metastases, distant metastases and synchronous cancers in patients with penile squamous cell carcinoma (pSCC). Patients and Methods During a 4‐year period, patients with pSCC were scheduled for FDG PET/CT prior to surgical treatment at two referral centres that manage all penile cancers in Denmark. The primary endpoint was diagnostic accuracy of FDG PET/CT and of CT alone with histopathology or Response Evaluation Criteria In Solid Tumors (RECIST) as reference. Results We evaluated 171 patients for distant metastases and synchronous incident cancers and examined 286 groins in 143 patients for LN metastases by FDG PET/CT. Six groins disclosed false negatives. FDG PET/CT sensitivity was 85.4% per patient. In 135 patients (270 groins), CT images were evaluated separately and 22 groins disclosed false negatives. CT sensitivity was 47.5% per patient. FDG PET/CT detected pSCC distant metastases in seven patients. Distant metastases from other cancers were newly detected in three patients. In eight patients, an incidental synchronous cancer was detected. Seven out of the 18 distant malignancies detected depended on FDG PET information. Conclusion This study underlines the increased diagnostic accuracy of FDG PET/CT compared to CT alone in the evaluation of ILN status. In patients with palpable LNs, the advantage of FDG PET/CT over CT is less pronounced. FDG PET/CT may play a role in penile cancer evaluation.

Diagnostic Performance of 18F-FDG PET/CT for Lymph Node Staging in Penile Cancer

“…The remaining 14 full-text articles were assessed for eligibility, and 2 articles were excluded due to insufficient data for the calculation of sensitivity and specificity of 18 F-FDG PET/CT for detection of LN metastasis in PeCA patients. Finally, 12 studies were selected and were eligible for the systematic review and meta-analysis, and no additional studies were found screening the references of these articles 20–31 . The characteristics of the included studies are presented in Table 1.…”

Imaging for the Initial Staging and Post-Treatment Surveillance of Penile Squamous Cell Carcinoma

“…A meta-analysis from 2012 found that due to low sensitivity (particularly in clinically node-negative patients), routine use of FDG-PET/CT is not justified, but that patients with clinically positive lymph nodes may benefit from PET/CT [ 31 ]. However, a Danish study prospectively compared FDG-PET/CT to contrast-enhanced CT in 171 patients and found a significant improvement in diagnostic accuracy of FDG-PET/CT compared to CT alone [ 32 ]. The same group also explored the use of FDG-PET/CT in combination with sentinel node biopsy localized by lymphoscintigraphy, which led to only a 5.6% false negative rate of sentinel node biopsy in patients who were clinically node negative [ 33 ].…”

Guia de cáncer de pene de la Sociedad Colombiana de Urología

“…Se debe realizar un examen físico exhaustivo de la región inguinal para determinar el número de lesiones, la lateralidad, y las características de los ganglios. En el caso de que no haya enfermedad nodal papable, se debe ofrecer estratificación invasiva en pacientes de riesgo intermedio y alto y, como sean palpables, se debe realizar exámenes de imágenes de extensión con tomografía axial computarizada (TAC) de abdomen, 16 tomografía por emisión de positrones, 17,18 y radiografía de tórax como estudio de extensión 19 (grado de recomendación: fuerte). En pacientes con enfermedad metastásica a distancia o que presente síntomas relevantes como el dolor oseo se debe obtener una gamagrafía osea, con grado de recomendación fuerte.…”