Diagnostic Performance of Magnetic Resonance Imaging for Preoperative Local Staging of Penile Cancer: A Systematic Review and Meta-Analysis

Abstract

Invasion of the tunica albuginea (TA) and/or urethra are key factors in determining the feasibility of organ-preserving surgery in penile cancer (PC). Magnetic resonance imaging (MRI) appeared to be a promising technique for preoperative local staging. We performed a systematic review (SR) and pooled meta-analysis to investigate the diagnostic performance of MRI in preoperative local staging of primary PC. An SR up to May 2021 was performed according to the PRISMA statement. The diagnostic performance of MRI was evaluated according to TA invasion, urethra invasion, and pT-stage ≥ 2. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) from eligible studies were pooled and summary receiver operating characteristic (SROC) curves were constructed. Overall, seven qualified studies were deemed suitable. Diagnostic performance of MRI showed an accuracy of 0.89 for TA invasion (sensitivity 0.78, PPV 0.79, specificity 0.91, and NPV 0.90); an accuracy of 0.88 for urethra invasion (sensitivity 0.65, PPV 0.46, specificity 0.86, and NPV 0.93); an accuracy of 0.90 for pT ≥ 2 (sensitivity 0.86, PPV 0.84, specificity 0.70, and NPV 0.73).Currently available evidence indicates that MRI might be a one-stop shop for local staging of primary PC and play a central role with regard to conservative surgical management.

Preoperative Albumin-to-Alkaline Phosphatase Ratio as an Independent Predictor of Lymph Node Involvement in Penile Cancer

“…Despite the potentially life-saving recommendations, trends still indicate a suboptimal adherence to PC guidelines [ 10 , 11 ]. Establishing novel prognostic indicators is crucial for a correct risk stratification of PC patients, providing valuable guidance for clinical management decisions and follow-up strategies [ 12 , 13 ]. In this scenario, several systemic inflammation biomarkers, including C-reactive protein (CRP), platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, and neutrophil-to-lymphocyte ratio have been proposed as potential prognostic factors in PC [ 14 , 15 ].…”

Sexual Outcomes after Conservative Management for Patients with Localized Penile Cancer

“…More than half of cases recognize human papillomavirus infection as the main etiological factor, followed by phimosis, tobacco exposure, poor hygiene, and multiple urinary tract infection [2][3][4]. According to clinical presentation, surgical treatment for localized PC can be divided into demolitive (partial or radical penectomy) or conservative treatments, such atopical therapy, laser ablation, wide local excision (WLE), and glansectomy [1,5]. Conservative treatments are usually reserved for patients with localized tumors (c ≤ T2) with the aim of eradicating the entire cancer, obtaining free margins of excision and sparing the organ [6].…”