Abstract
1411
Objectives To find out the diagnostic value of F-18 FDG PET/CT in initial staging and restaging of penile cancer with an emphasis on detection of lymph nodal involvement.
Methods Clinical and PET/CT data of 27 patients with penile cancer, who underwent F-18 FDG PET/CT as a part of initial staging or restaging were retrospectively analyzed. The reference standard was based on histopathology findings of biopsy/surgery, clinical and/or imaging follow up.
Results Twenty seven of carcinoma penis, 11 for initial staging and 16 for restaging after initial treatment with curative intent, were included in the analysis. F-18 FDG uptake was noted in the primary tumor in all the 11 patients referred for initial staging. Lymph nodal metastases were noted in 9 patients which were confirmed by surgery in 8 patients; one patient died due to haemorrhage by lymph nodal invasion into femoral artery confirming metastases. Two patients with no evidence of lymph nodal metastases on PET/CT underwent penectomy and inguinal lymph node dissection which did not reveal metastases and both were disease free at 6 months follow up. Of the 16 patients for restaging, six had negative PET/CT and eight showed lymph nodal residual disease (7 confirmed histopathologically) , one had multiple distant metastases and one had only penile residual disease. All 6 patients with negative PET/CT study were free of disease on clinical follow up. One patient with multiple distant metastases died during follow up. Also one patient with suspicion of residual disease in penile stump was proven to false positive as patient remained free of disease during follow up without any intervention. PET/CT had sensitivity, specificity, PPV and NPV of 100%, 85.7%, 87.5% and 100% respectively in detecting the lymph nodal involvement at restaging.
Conclusions Our results suggest that F-18 FDG PET/CT is highly accurate in detecting lymph nodal metastases during initial staging and restaging in patients with penile cancer and can be useful in deciding appropriate treatment strategy