title: 18F-FDG PET/CT for staging of penile cancer.
abstract: The value of PET or PET/CT with (18)F-FDG for the staging of penile cancer has yet to be determined. The objective of this study was to investigate the pattern of (18)F-FDG uptake in the primary malignancy and its metastases and to determine the diagnostic value of (18)F-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 (18)F-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 (18)F-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.
  
  
  CONCLUSIONS
  According to our results, the main indication for (18)F-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 (18)F-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.
authors.affiliation: Department of Nuclear Medicine, University of Munich, Munich, Germany. Bernhard.Scher@med.uni-muenchen.de
authors.forename: Bernhard
authors.initials: B
authors.lastname: Scher
authors.forename: Michael
authors.initials: M
authors.lastname: Seitz
authors.forename: Martin
authors.initials: M
authors.lastname: Reiser
authors.forename: Edwin
authors.initials: E
authors.lastname: Hungerhuber
authors.forename: Klaus
authors.initials: K
authors.lastname: Hahn
authors.forename: Reinhold
authors.initials: R
authors.lastname: Tiling
authors.forename: Peter
authors.initials: P
authors.lastname: Herzog
authors.forename: Maximilian
authors.initials: M
authors.lastname: Reiser
authors.forename: Peter
authors.initials: P
authors.lastname: Schneede
authors.forename: Stefan
authors.initials: S
authors.lastname: Dresel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000175:diagnosis* / Q000556:secondary*; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010412:Penile Neoplasms / Q000145:classification* / Q000175:diagnosis; D049268:Positron-Emission Tomography / Q000379:methods*; D011379:Prognosis; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013382:Subtraction Technique; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18