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¹⁸F-FDG PET/CT for Staging of Penile Cancer

¹ Department of Nuclear Medicine, University of Munich, Munich, Germany
² Department of Urology, University of Munich, Munich, Germany
³ Department of Radiology, University of Munich, Munich, Germany

The value of PET or PET/CT with ¹⁸F-FDG for the staging of penile cancer has yet to be determined. The objective of this study was to investigate the pattern of ¹⁸F-FDG uptake in the primary malignancy and its metastases and to determine the diagnostic value of ¹⁸F-FDG PET/CT in the staging and restaging of penile cancer. Methods: Thirteen patients (mean ± SD age, 64 ± 14.0 y) with suspected penile cancer or suspected recurrent disease were examined with a Gemini PET/CT system (200 MBq of ¹⁸F-FDG). The reference standard was based on histopathologic findings obtained at biopsy or during surgery. Results: Both the primary tumor and regional lymph node metastases exhibited a pattern of ¹⁸F-FDG uptake typical for malignancy. Sensitivity in the detection of primary lesions was 75% (6/8), and specificity was 75% (3/4). On a per-patient basis, sensitivity in the detection of lymph node metastases was 80% (4/5), and specificity was 100% (8/8). On a nodal-group basis, PET/CT showed a sensitivity of 89% (8/9) in the detection of metastases in the superficial inguinal lymph node basins and a sensitivity of 100% (7/7) in the deep inguinal and obturator lymph node basins. The mean ± SD maximum standardized uptake value for the 8 primary lesions was 5.3 ± 3.7, and that for the 16 lymph node metastases was 4.6 ± 2.0. Conclusion: According to our results, the main indication for ¹⁸F-FDG PET in the primary staging or follow-up of penile cancer patients may be the prognostically crucial search for lymph node metastases. With the use of a PET/CT unit, the additional information provided by CT may be especially useful for planning surgery. Implementing ¹⁸F-FDG PET and PET/CT in future staging algorithms may lead to a more precise and stage-appropriate therapeutic strategy. Furthermore, invasive procedures with a high morbidity rate, such as general bilateral lymphadenectomy, may be avoided.

Key Words: PET/CT • ¹⁸F-FDG • penile cancer

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