Prospective evaluation of (18)F-fluorodeoxyglucose positron emission tomography-computerized tomography to assess inguinal lymph node status in invasive squamous cell carcinoma of the penis.

PURPOSE: We prospectively evaluated (18)F-fluorodeoxyglucose positron emission tomography-computerized tomography to assess inguinal lymph node status, the main prognostic factor in invasive squamous cell carcinoma of the penis. MATERIALS AND METHODS: From March 2005 to January 2010, 30 patients with invasive squamous cell carcinoma of the penis from the department of urology at our institution were prospectively included in this study. Lymph node status was assessed preoperatively by positron emission tomography-computerized tomography to detect subclinical metastasis in 22 patients with initially cN0 disease and quantify inguinal lymph node invasion in 8 with cN+. RESULTS: In the 22 cN0 cases (total of 44 inguinal lymph node basins analyzed) positron emission tomography-computerized tomography had 75% sensitivity and 87.5% specificity. Positive and negative predictive values were 37.5% and 97.2%, respectively. In the 8 cN+ cases (total of 16 inguinal lymph node basins analyzed) this type of imaging had 100% sensitivity, specificity and positive predictive value. In 3 cases staged clinically as cN1 positron emission tomography-computerized tomography revealed several metabolically active lesions on the same side, which was confirmed by histological examination, up-staging these cases to pN2. CONCLUSIONS: (18)F-fluorodeoxyglucose positron emission tomography-computerized tomography is a useful staging examination for invasive penile cancer. It confirms inguinal lymph node invasion and can detect subclinical inguinal lymph node invasion.

Long-term followup of penile carcinoma with high risk for lymph node invasion treated with inguinal lymphadenectomy.

PURPOSE: The current penile cancer problem is defining lymph node invasion types for which inguinal lymphadenectomy is effective in terms of patient survival and the number of inguinal metastases beyond which combination therapy should be proposed. We evaluated survival of patients with penile cancer at high risk for lymph node invasion treated with inguinal lymphadenectomy. MATERIALS AND METHODS: A total of 114 patients underwent lymphadenectomy for penile cancer with no palpable inguinal lymph nodes (cN0) but at intermediate or high risk for lymph node invasion, or with 1 or several palpable inguinal lymph nodes (cN1-3). All patients were initially treated for primary penile cancer with clinical and pathological inguinal lymph node staging. Bilateral superficial superomedial, ipsilateral radical plus contralateral modified and bilateral radical procedures were done in 50 cN0, 35 cN1 and 29 cN2-3 cases, respectively. Overall specific and recurrence-free survival was calculated by Kaplan-Meier curves with differences calculated by the log rank test. RESULTS: Five-year disease-free survival was 93.4%, 83.7%, 32% and 0% for stages cN0 to cN3, and 93.4%, 89.7%, 30.9% and 0% for stages pN0 to pN3, respectively, with a statistically significant difference for cN0-1 vs cN2-3 and pN0-1 vs pN2-3 (p <0.001). The recurrence rate was 10.5%, 10.3%, 32.6% and 30.0% for stages pN0 to pN3, respectively. CONCLUSIONS: After inguinal lymphadenectomy specific and recurrence-free survival in cN1 and pN1 cases was comparable to that in cN0 and pN0 cases. The recurrence rate in the latter was higher than for other occult inguinal metastasis detection techniques. Only superomedial inguinal lymph nodes were studied, missing central and lateral superior zone occult metastasis. Survival was poor in patients with more than 2 lymph nodes invaded. In those cases chemotherapy protocols or chemotherapy combined with lymphadenectomy must be evaluated.