Evaluation of positron emission tomography imaging to detect lymph node metastases in patients with extramammary Paget's disease

Fujiwara, Masao; Suzuki, Takahiro; Senoo, Ayumi; Fukamizu, Hidekazu; Tokura, Y.

doi:10.1111/1346-8138.13833

Cited by 12 publications

(10 citation statements)

References 32 publications

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“…In the present study, PET/CT was performed immediately prior to surgery for each of the patients and showed a high association with the final pathology. Previous studies have revealed that regardless of LN swelling, the SUVmax of LN-positive cases is significantly higher compared with that of LN-negative cases (22). A study of 33 patients showed that the sensitivity and specificity of PET/CT in detecting metastatic LNs were 75.0 and 96.4%, respectively (23).…”

Section: Discussionmentioning

confidence: 92%

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Human epidermal growth factor receptor 2 amplification as a biomarker for treatment in patients with lymph node‑metastatic penoscrotal extramammary Paget's disease

et al. 2019

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The role of human epidermal growth factor receptor 2 (HER2) amplification as a biomarker for treatment in patients with lymph node (LN)-metastatic penoscrotal extramammary Paget's disease (EMPD) was investigated in the present study. A total of 11 male patients with LN-metastatic penoscrotal EMPD were retrospectively reviewed. Positron emission tomography/computed tomography (PET/CT) was conducted prior to surgery. Immunohistochemistry and fluorescence in situ hybridization were used to evaluate HER2 gene amplification in LN samples. Sanger sequencing was used to investigate HER2 mutations. A literature review of the prevalence of HER2 amplification in EMPD and the efficacy of HER2-targeted therapy was also undertaken. PET/CT is effective in detecting metastatic sites. The sensitivity and specificity of PET/CT was 90.9 and 100.0% for inguinal LNs, and 85.7 and 80.0% for pelvic LNs, respectively. The median time from LN dissection to disease progression was 15.9±1.5 months. Of the 11 patients, 3 (27.3%) indicated HER2 amplification. Patients with HER2 amplification showed shorter median times from disease discovery to LN metastasis (HER2 amplification vs HER2 non-amplification; 15.6 vs. 10.0 months; P=0.50) and from LN dissection to disease progression (HER2 amplification vs. HER2 non-amplification, 16.2 vs. 13.6 months; P=0.11). However, the aforementioned observations were not indicated to be statistically significant. No HER2 mutations were identified. Trastuzumab, a HER2-targeted monoclonal antibody, was administered to 2 of the patients with HER2 amplification. A literature review of the prevalence of HER2 amplification in EMPD and the efficacy of HER2-targeted therapy showed similar results. Altogether, 485 cases of EMPD were reported, 35 of which had metastases. The results in the present study suggest that PET/CT should be used on all metastatic EMPD patients. EMPD may be effectively treated with trastuzumab. The present study and case reports from the literature provide evidence for the benefit of testing for HER2 amplification in this rare disease and highlight the requirement for a multicenter clinical trial to assess the impact of trastuzumab therapy in treating this disease.

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Section: Discussionmentioning

confidence: 92%

“…There have been several case reports on the use of PET/CT in LN-metastatic EMPD cases. These previous studies have revealed that the maximum standardized uptake value (SUVmax) may be useful for detecting nodal metastasis in EMPD cases (3,5–7).…”

Section: Introductionmentioning

confidence: 99%

Human epidermal growth factor receptor 2 amplification as a biomarker for treatment in patients with lymph node‑metastatic penoscrotal extramammary Paget's disease

et al. 2019

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“…FDG‐avidity can also help detect true nodal metastasis. Fujiwara and colleagues examined the relationship between SUV max values and lymph node metastasis . They found that SUV max is potentially useful to when evaluating the need for sentinel lymph node biopsy (SLNB) in EMPD.…”

Section: Resultsmentioning

confidence: 99%

A review of non‐invasive imaging in extramammary Paget's disease

Bayan

Khanna

Rotemberg

et al. 2018

Acad Dermatol Venereol

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Extramammary Paget's Disease (EMPD) is a rare intraepithelial adenocarcinoma that classically manifests with pruritic, erythematous and scaling plaques. The clinical picture frequently mimics inflammatory or infectious conditions and is thus commonly misdiagnosed. The assessment of tumour margins is equally challenging as tumours have a propensity to spread beyond clinically visible boundaries. Appropriate non-invasive diagnostic tools can assist in the early detection, diagnosis and management of EMPD. This paper will review the literature on non-invasive imaging modalities used in EMPD. Articles from the PubMed database were selected based on relevance to the topic of this review. Articles that were not specific to EMPD and non-invasive imaging were excluded. Search strategy is further described in the methods section below. Eighteen articles were selected for this review: six PET/CT, five reflectance confocal microscopy (RCM), two photodynamic diagnosis (PDD), two dermoscopy, two MRI and one optical coherence tomography (OCT) paper(s). Dermoscopy, PDD, RCM and OCT can help to distinguish malignant conditions, including EMPD, from benign conditions. RCM and OCT can identify atypical cells in real-time, and have the potential to improve the accuracy of surgical margins intraoperatively and overall management. Distinctive confocal characteristics of EMPD have been described using RCM. The sensitivity and specificity of these findings require additional validation. Radiographic techniques also play a central role in the diagnosis of EMPD and assessment of disease spread. PET/CT and MRI can detect primary disease, nodal and distant metastases, with superior delineation of disease spread on MRI. Limitations of PET/CT are mainly related to primary tumour thickness, and size and FDG-avidity of nodal and distant metastases. Limitations of MRI include the fact that few studies have examined its use in EMPD; additional research is warranted. Randomized controlled trials and large prospective studies evaluating the use of non-invasive imaging in EMPD are needed.

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“…Positron emission tomography images have been reported to be effective for detecting LNM in patients with EMPD. 22 On the other hand, for early EMPD management with no clinical evidence of nodal metastases, some authors have suggested the use of sentinel lymph node (SLN) biopsy. [10][11][12] This suggests that a significant proportion of patients with no initial clinical evidence of nodal metastases may harbor clinically silent micrometastases, and confirmation of lymph node disease by SLN biopsy or imaging can help determine treatment strategy.…”

Section: Discussionmentioning

confidence: 99%

“…Enlargement of regional nodes is caused by previous or concurrent infections and inflammation, leading to reactive lymphadenopathy; thus, accurate clinical diagnosis is difficult. Positron emission tomography images have been reported to be effective for detecting LNM in patients with EMPD . On the other hand, for early EMPD management with no clinical evidence of nodal metastases, some authors have suggested the use of sentinel lymph node (SLN) biopsy .…”

Section: Discussionmentioning

confidence: 99%

Outcomes of lymph node dissection in the treatment of extramammary Paget’s disease: A single‐institution study

Tsutsui

Takahashi²,

Muto³

et al. 2020

The Journal of Dermatology

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Extramammary Paget's disease (EMPD) often invades the dermis and metastasizes to the lymph nodes. Patients with EMPD associated with lymph node metastases have poor prognosis; to date, effective treatment has not yet been established. Lymph node dissection, aiming to control the local disease, is a standard form of management for EMPD patients with lymph node metastases (LNM). We investigated the clinical and pathological features, treatment strategies and prognostic factors of patients with metastatic EMPD who underwent lymph node dissection. We retrospectively evaluated 38 cases of extramammary Paget's disease with lymph node metastasis over 10 years. All patients underwent wide resection of the primary lesion and lymph node dissection. Univariate analysis revealed the number of metastatic nodes and lymphadenopathy as prognostic factors. In multivariate analysis, the number of metastatic lymph nodes retained statistical significance (hazard ratio, 35.3; 95% confidence interval, 3.23-387.0; P = 0.003). The 5-year survival rate was 100% and 19.1% in patients with two or less LNM and with three or more LNM, respectively. In patients with three or more LNM, the 5-year survival rate after adjuvant radiation therapy was better than that after surgery alone (75% vs 0%). In conclusion, patients with two or less LNM can be expected to have long-term survival with lymph node dissection only, while patients with three or more LNM may require adjuvant radiation therapy to improve prognosis. These results suggest that lymph node dissection may be a strategy to treat EMPD with regional LNM. METHODS PatientsThis retrospective analysis examined a prospectively maintained database of 89 EMPD patients with dermal invasion who were treated at

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Evaluation of positron emission tomography imaging to detect lymph node metastases in patients with extramammary Paget's disease

Cited by 12 publications

References 32 publications

Human epidermal growth factor receptor 2 amplification as a biomarker for treatment in patients with lymph node‑metastatic penoscrotal extramammary Paget's disease

Human epidermal growth factor receptor 2 amplification as a biomarker for treatment in patients with lymph node‑metastatic penoscrotal extramammary Paget's disease

A review of non‐invasive imaging in extramammary Paget's disease

Outcomes of lymph node dissection in the treatment of extramammary Paget’s disease: A single‐institution study

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