title: Incremental value of MRI for preoperative penile cancer staging.
abstract: To evaluate the incremental value of magnetic resonance imaging (MRI), compared to clinical examination, for penile cancer (PC) local staging.
  
  
  
  Twenty-five consecutive patients with histologically proven PC were evaluated prospectively. MRI staging was performed on 1.5 and 3.0T scanners using high-resolution T2-weighted and postcontrast T1-weighted images. Two blinded observers interpreted MR images. Clinical local staging was performed by experienced urologists. The pathology report was used as the standard of reference.
  
  
  
  The interobserver agreement for MRI staging, using a kappa test for T-staging was moderate, 0.52 (95% confidence interval [CI] = 0.24-0.78), P = 0.001, although a high correlation for N-staging, 0.72 (95% CI = 0.42-1.00), P = 0.001, was detected. Clinical staging was correct in 52.0% (13/25) of patients. After pathological staging, five (20.0%) lesions were upstaged and seven (28.0%) lesions were downstaged compared to clinical examination. MRI accurately defined T-staging in 18/25 lesions (72.0%). After pathologic staging, five (20.0%) were upstaged and two downstaged (8.0%), compared to MRI. Fifteen patients were submitted to inguinal and pelvic lymphadenectomy and considered for comparison of accuracy of nodal staging by physical examination and MRI. Clinical staging accurately staged 7/15 patients (46.7%). After histopathologic analysis, six cases had nodal staging upgraded and two cases were downgraded. MRI correctly staged 13/15 (86.7%). Using a chi-square for comparison, differences in proportion of corrected staging between clinical examination and MRI were not significant for T-staging (P = 0.14), but were significant for nodal staging (P = 0.02).
  
  
  
  According to our results, MRI improves local staging of PC patients, particularly for those with limited physical examination.
  
  
  
  1 J. Magn. Reson. Imaging 2017;45:118-124.
authors.affiliation: Department of Radiology, Barretos Cancer Hospital, Pio XII Foundation, Barretos, Brazil.
authors.forename: Fabiano Rubião
authors.initials: FR
authors.lastname: Lucchesi
authors.affiliation: Department of Surgery, Urology Division, Ribeirao Preto Medical School, University of Sao Paulo, Brazil.
authors.forename: Rodoldo Borges
authors.initials: RB
authors.lastname: Reis
authors.affiliation: Department of Urology, Barretos Cancer Hospital, Pio XII Foundation, Barretos, Brazil.
authors.forename: Eliney Ferreira
authors.initials: EF
authors.lastname: Faria
authors.affiliation: Department of Urology, Barretos Cancer Hospital, Pio XII Foundation, Barretos, Brazil.
authors.forename: Roberto Dias
authors.initials: RD
authors.lastname: Machado
authors.affiliation: Department of Radiology, Barretos Cancer Hospital, Pio XII Foundation, Barretos, Brazil.
authors.forename: Rodrigo Ribeiro
authors.initials: RR
authors.lastname: Rossini
authors.affiliation: Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Leonardo D
authors.initials: LD
authors.lastname: Borregales
authors.affiliation: Department of Pathology, Ribeirao Preto Medical School, University of Sao Paulo, Brazil.
authors.forename: Gyl Eanes Barros
authors.initials: GE
authors.lastname: Silva
authors.affiliation: Internal Medicine Department, Imaging Division, Ribeirao Preto Medical School, University of Sao Paulo, Brazil.
authors.forename: Valdair Francisco
authors.initials: VF
authors.lastname: Muglia
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010412:Penile Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
keywords: MRI; cancer staging; penile cancer