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Evolving Imaging Modalities in the Diagnosis and Staging of Penile Cancer

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Penile Cancer

Part of the book series: Current Clinical Urology ((CCU))

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Abstract

Accurate staging of penile cancer is of paramount importance in the evaluation of a patient presenting with this malignancy as well as in devising an optimized therapeutic approach. Squamous cell carcinoma (SCC) of the penis has a relatively predictable pattern of metastatic spread via the lymphatic system. It is this reliable pattern of spread which makes this disease one of the rare malignancies in which a thorough and effective resection of regional lymphatic involvement can result in potential cure. Metastatic spread of SCC from the penis first involves the superficial and deep inguinal lymph nodes, followed by the pelvic lymph nodes. The presence of metastatic disease in the regional lymph nodes and the extent of lymph node involvement are vital determinants of patient survival. Local staging of penile cancer and an understanding of the invasiveness and extent of the primary tumor are also essential for adequate surgical planning. Adequate preoperative assessment of local clinical staging allows for effective decision making for penile sparing surgery (partial penectomy, wide local excision) versus the necessity for a more radical local resection. Moreover, it allows a frank discussion with the patient as to what can be expected postoperatively. A detailed discussion of the postsurgical appearance of the external genitalia is critical for the patient’s psychological well-being.

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References

  1. Edge SB, American Joint Committee on Cancer. AJCC cancer staging manual. 7th ed. New York: Springer; 2010.

    Google Scholar 

  2. Feldman AS, McDougal WS. Long-term outcome of excisional organ sparing surgery for carcinoma of the penis. J Urol. 2011;186(4):1303–7.

    Article  PubMed  Google Scholar 

  3. McDougal WS, Kirchner Jr FK, Edwards RH, Killion LT. Treatment of carcinoma of the penis: the case for primary lymphadenectomy. J Urol. 1986;136(1):38–41.

    PubMed  CAS  Google Scholar 

  4. Horenblas S, van Tinteren H, Delemarre JF, Moonen LM, Lustig V, van Waardenburg EW. Squamous cell carcinoma of the penis. III. Treatment of regional lymph nodes. J Urol. 1993;149(3):492–7.

    PubMed  CAS  Google Scholar 

  5. McDougal WS. Carcinoma of the penis: improved survival by early regional lymphadenectomy based on the histological grade and depth of invasion of the primary lesion. J Urol. 1995;154(4):1364–6.

    Article  PubMed  CAS  Google Scholar 

  6. Slaton JW, Morgenstern N, Levy DA, Santos Jr MW, Tamboli P, Ro JY, et al. Tumor stage, vascular invasion and the percentage of poorly differentiated cancer: independent prognosticators for inguinal lymph node metastasis in penile squamous cancer. J Urol. 2001;165(4):1138–42.

    Article  PubMed  CAS  Google Scholar 

  7. Ficarra V, Zattoni F, Artibani W, Fandella A, Martignoni G, Novara G, et al. Nomogram predictive of pathological inguinal lymph node involvement in patients with squamous cell carcinoma of the penis. J Urol. 2006;175(5):1700–4. discussion 1704–5.

    Article  PubMed  Google Scholar 

  8. Guimaraes GC, Lopes A, Campos RS, Zequi Sde C, Leal ML, Carvalho AL, et al. Front pattern of invasion in squamous cell carcinoma of the penis: new prognostic factor for predicting risk of lymph node metastases. Urology. 2006;68(1):148–53.

    Article  PubMed  Google Scholar 

  9. Dai B, Ye DW, Kong YY, Yao XD, Zhang HL, Shen YJ. Predicting regional lymph node metastasis in chinese patients with penile squamous cell carcinoma: The role of histopathological classification, tumor stage and depth of invasion. J Urol. 2006;176(4 Pt 1):1431–5. discussion 1435.

    Article  PubMed  Google Scholar 

  10. Lopes A, Hidalgo GS, Kowalski LP, Torloni H, Rossi BM, Fonseca FP. Prognostic factors in carcinoma of the penis: Multivariate analysis of 145 patients treated with amputation and lymphadenectomy. J Urol. 1996;156(5):1637–42.

    Article  PubMed  CAS  Google Scholar 

  11. Pizzocaro G, Algaba F, Horenblas S, Solsona E, Tana S, Van Der Poel H, et al. EAU penile cancer guidelines 2009. Eur Urol. 2010;57(6):1002–12.

    Article  PubMed  Google Scholar 

  12. Lont AP, Besnard AP, Gallee MP, van Tinteren H, Horenblas S. A comparison of physical examination and imaging in determining the extent of primary penile carcinoma. BJU Int. 2003;91(6):493–5.

    Article  PubMed  CAS  Google Scholar 

  13. Petralia G, Villa G, Scardino E, Zoffoli E, Renne G, de Cobelli O, et al. Local staging of penile cancer using magnetic resonance imaging with pharmacologically induced penile erection. Radiol Med. 2008;113(4):517–28.

    Article  PubMed  CAS  Google Scholar 

  14. Raghavaiah NV. Corpus cavernosogram in the evaluation of carcinoma of the penis. J Urol. 1978;120(4):423–4.

    PubMed  CAS  Google Scholar 

  15. Escribano G, Allona A, Burgos FJ, Garcia R, Navio S, Escudero A. Cavernosography in diagnosis of metastatic tumors of the penis: 5 new cases and a review of the literature. J Urol. 1987;138(5):1174–7.

    PubMed  CAS  Google Scholar 

  16. Haddad FS, Kovac A, Kivirand A, Sonkin B. Cavernosography in diagnosis of penile metastases secondary to bladder cancer. Urology. 1985;26(6):585–6.

    Article  PubMed  CAS  Google Scholar 

  17. Bertolotto M, Serafini G, Dogliotti L, Gandolfo N, Gandolfo NG, Belgrano M, et al. Primary and secondary malignancies of the penis: ultrasound features. Abdom Imaging. 2005;30(1):108–12.

    Article  PubMed  CAS  Google Scholar 

  18. Horenblas S, Kroger R, Gallee MP, Newling DW, van Tinteren H. Ultrasound in squamous cell carcinoma of the penis; a useful addition to clinical staging? A comparison of ultrasound with histopathology. Urology. 1994;43(5):702–7.

    Article  PubMed  CAS  Google Scholar 

  19. Solsona E, Algaba F, Horenblas S, Pizzocaro G, Windahl T. European Association of Urology. EAU guidelines on penile cancer. Eur Urol. 2004;46(1):1–8.

    Article  PubMed  CAS  Google Scholar 

  20. Stewart SB, Leder RA, Inman BA. Imaging tumors of the penis and urethra. Urol Clin North Am. 2010;37(3):353–67.

    Article  PubMed  Google Scholar 

  21. Kochhar R, Taylor B, Sangar V. Imaging in primary penile cancer: current status and future directions. Eur Radiol. 2010;20(1):36–47.

    Article  PubMed  Google Scholar 

  22. Fujita H. New horizons in MR technology: RF coil designs and trends. Magn Reson Med Sci. 2007;6(1):29–42.

    Article  PubMed  Google Scholar 

  23. Scardino E, Villa G, Bonomo G, Matei DV, Verweij F, Rocco B, et al. Magnetic resonance imaging combined with artificial erection for local staging of penile cancer. Urology. 2004;63(6):1158–62.

    Article  PubMed  CAS  Google Scholar 

  24. Dewire D, Lepor H. Anatomic considerations of the penis and its lymphatic drainage. Urol Clin North Am. 1992;19(2):211–9.

    PubMed  CAS  Google Scholar 

  25. Ravi R. Correlation between the extent of nodal involvement and survival following groin dissection for carcinoma of the penis. Br J Urol. 1993;72(5 Pt 2):817–9.

    Article  PubMed  CAS  Google Scholar 

  26. Srinivas V, Morse MJ, Herr HW, Sogani PC, Whitmore Jr WF. Penile cancer: relation of extent of nodal metastasis to survival. J Urol. 1987;137(5):880–2.

    PubMed  CAS  Google Scholar 

  27. Ornellas AA, Seixas AL, Marota A, Wisnescky A, Campos F, de Moraes JR. Surgical treatment of invasive squamous cell carcinoma of the penis: retrospective analysis of 350 cases. J Urol. 1994;151(5):1244–9.

    PubMed  CAS  Google Scholar 

  28. Theodorescu D, Russo P, Zhang ZF, Morash C, Fair WR. Outcomes of initial surveillance of invasive squamous cell carcinoma of the penis and negative nodes. J Urol. 1996;155(5):1626–31.

    Article  PubMed  CAS  Google Scholar 

  29. Hardner GJ, Bhanalaph T, Murphy GP, Albert DJ, Moore RH. Carcinoma of the penis: analysis of therapy in 100 consecutive cases. J Urol. 1972;108(3):428–30.

    PubMed  CAS  Google Scholar 

  30. Bhagat SK, Gopalakrishnan G, Kekre NS, Chacko NK, Kumar S, Manipadam MT, et al. Factors predicting inguinal node metastasis in squamous cell cancer of penis. World J Urol. 2010;28(1):93–8.

    Article  PubMed  Google Scholar 

  31. Spiess PE, Hernandez MS, Pettaway CA. Contemporary inguinal lymph node dissection: minimizing complications. World J Urol. 2009;27(2):205–12.

    Article  PubMed  Google Scholar 

  32. Hughes B, Leijte J, Shabbir M, Watkin N, Horenblas S. Non-invasive and minimally invasive staging of regional lymph nodes in penile cancer. World J Urol. 2009;27(2):197–203.

    Article  PubMed  Google Scholar 

  33. Esen G. Ultrasound of superficial lymph nodes. Eur J Radiol. 2006;58(3):345–59.

    Article  PubMed  Google Scholar 

  34. Steinkamp HJ, Mueffelmann M, Bock JC, Thiel T, Kenzel P, Felix R. Differential diagnosis of lymph node lesions: a semiquantitative approach with colour doppler ultrasound. Br J Radiol. 1998;71(848):828–33.

    PubMed  CAS  Google Scholar 

  35. Crawshaw JW, Hadway P, Hoffland D, Bassingham S, Corbishley CM, Smith Y, et al. Sentinel lymph node biopsy using dynamic lymphoscintigraphy combined with ultrasound-guided fine needle aspiration in penile carcinoma. Br J Radiol. 2009;82(973):41–8.

    Article  PubMed  CAS  Google Scholar 

  36. Tabatabaei S, Harisinghani M, McDougal WS. Regional lymph node staging using lymphotropic nanoparticle enhanced magnetic resonance imaging with ferumoxtran-10 in patients with penile cancer. J Urol. 2005;174(3):923–7. discussion 927.

    Article  PubMed  Google Scholar 

  37. Graafland NM, Teertstra HJ, Besnard AP, van Boven HH, Horenblas S. Identification of high risk pathological node positive penile carcinoma: value of preoperative computerized tomography imaging. J Urol. 2011;185(3):881–7.

    Article  PubMed  Google Scholar 

  38. Jung CW, Jacobs P. Physical and chemical properties of superparamagnetic iron oxide MR contrast agents: ferumoxides, ferumoxtran, ferumoxsil. Magn Reson Imaging. 1995;13(5):661–74.

    Article  PubMed  CAS  Google Scholar 

  39. Weissleder R, Elizondo G, Wittenberg J, Lee AS, Josephson L, Brady TJ. Ultrasmall superparamagnetic iron oxide: an intravenous contrast agent for assessing lymph nodes with MR imaging. Radiology. 1990;175(2):494–8.

    PubMed  CAS  Google Scholar 

  40. Weissleder R, Elizondo G, Wittenberg J, Rabito CA, Bengele HH, Josephson L. Ultrasmall superparamagnetic iron oxide: characterization of a new class of contrast agents for MR imaging. Radiology. 1990;175(2):489–93.

    PubMed  CAS  Google Scholar 

  41. Guimaraes R, Clement O, Bittoun J, Carnot F, Frija G. MR lymphography with superparamagnetic iron nanoparticles in rats: pathologic basis for contrast enhancement. AJR Am J Roentgenol. 1994;162(1):201–7.

    Article  PubMed  CAS  Google Scholar 

  42. Clement O, Guimaraes R, de Kerviler E, Frija G. Magnetic resonance lymphography. Enhancement patterns using superparamagnetic nanoparticles. Invest Radiol. 1994;29 Suppl 2:S226–S8.

    Article  PubMed  Google Scholar 

  43. Bellin MF, Lebleu L, Meric JB. Evaluation of retroperitoneal and pelvic lymph node metastases with MRI and MR lymphangiography. Abdom Imaging. 2003;28(2):155–63.

    Article  PubMed  CAS  Google Scholar 

  44. Harisinghani MG, Barentsz JO, Hahn PF, Deserno W, de la Rosette J, Saini S, et al. MR lymphangiography for detection of minimal nodal disease in patients with prostate cancer. Acad Radiol. 2002;9 Suppl 2:S312–S3.

    Article  PubMed  Google Scholar 

  45. Pannu HK, Wang KP, Borman TL, Bluemke DA. MR imaging of mediastinal lymph nodes: Evaluation using a superparamagnetic contrast agent. J Magn Reson Imaging. 2000;12(6):899–904.

    Article  PubMed  CAS  Google Scholar 

  46. Harisinghani MG, Barentsz J, Hahn PF, Deserno WM, Tabatabaei S, van de Kaa CH, et al. Noninvasive detection of clinically occult lymph-node metastases in prostate cancer. N Engl J Med. 2003;348(25):2491–9.

    Article  PubMed  Google Scholar 

  47. Fletcher JW, Djulbegovic B, Soares HP, Siegel BA, Lowe VJ, Lyman GH, et al. Recommendations on the use of 18F-FDG PET in oncology. J Nucl Med. 2008;49(3):480–508.

    Article  PubMed  Google Scholar 

  48. Lardinois D, Weder W, Hany TF, Kamel EM, Korom S, Seifert B, et al. Staging of non-small-cell lung cancer with integrated positron-emission tomography and computed tomography. N Engl J Med. 2003;348(25):2500–7.

    Article  PubMed  Google Scholar 

  49. Antoch G, Saoudi N, Kuehl H, Dahmen G, Mueller SP, Beyer T, et al. Accuracy of whole-body dual-modality fluorine-18-2-fluoro-2-deoxy-d-glucose positron emission tomography and computed tomography (FDG-PET/CT) for tumor staging in solid tumors: Comparison with CT and PET. J Clin Oncol. 2004;22(21):4357–68.

    Article  PubMed  Google Scholar 

  50. Ng SH, Yen TC, Chang JT, Chan SC, Ko SF, Wang HM, et al. Prospective study of [18F]fluorodeoxyglucose positron emission tomography and computed tomography and magnetic resonance imaging in oral cavity squamous cell carcinoma with palpably negative neck. J Clin Oncol. 2006;24(27):4371–6.

    Article  PubMed  Google Scholar 

  51. Scher B, Seitz M, Reiser M, Hungerhuber E, Hahn K, Tiling R, et al. 18F-FDG PET/CT for staging of penile cancer. J Nucl Med. 2005;46(9):1460–5.

    PubMed  Google Scholar 

  52. Graafland NM, Leijte JA, Valdes Olmos RA, Hoefnagel CA, Teertstra HJ, Horenblas S. Scanning with 18F-FDG-PET/CT for detection of pelvic nodal involvement in inguinal node-positive penile carcinoma. Eur Urol. 2009;56(2):339–45.

    Article  PubMed  Google Scholar 

  53. Leijte JA, Graafland NM, Valdes Olmos RA, van Boven HH, Hoefnagel CA, Horenblas S. Prospective evaluation of hybrid 18F-fluorodeoxyglucose positron emission tomography/computed tomography in staging clinically node-negative patients with penile carcinoma. BJU Int. 2009;104(5):640–4.

    Article  PubMed  Google Scholar 

  54. Souillac I, Rigaud J, Ansquer C, Marconnet L, Bouchot O. 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. J Urol. 2012;187(2):493–7.

    Article  PubMed  Google Scholar 

  55. Sadeghi R, Gholami H, Zakavi SR, Kakhki VR, Horenblas S. Accuracy of 18F-FDG PET/CT for diagnosing inguinal lymph node involvement in penile squamous cell carcinoma: systematic review and meta-analysis of the literature. Clin Nucl Med. 2012;37(5):436–41.

    Article  PubMed  Google Scholar 

  56. Cabanas RM. An approach for the treatment of penile carcinoma. Cancer. 1977;39(2):456–66.

    Article  PubMed  CAS  Google Scholar 

  57. Cabanas RM. Anatomy and biopsy of sentinel lymph nodes. Urol Clin North Am. 1992;19(2):267–76.

    PubMed  CAS  Google Scholar 

  58. Perinetti E, Crane DB, Catalona WJ. Unreliability of sentinel lymph node biopsy for staging penile carcinoma. J Urol. 1980;124(5):734–5.

    PubMed  CAS  Google Scholar 

  59. Wespes E, Simon J, Schulman CC. Cabanas approach: is sentinel node biopsy reliable for staging penile carcinoma? Urology. 1986;28(4):278–9.

    Article  PubMed  CAS  Google Scholar 

  60. Srinivas V, Joshi A, Agarwal B, Mundhada U, Shah A, Phadke AG. Penile cancer—the sentinel lymph node controversy. Urol Int. 1991;47(2):108–9.

    Article  PubMed  CAS  Google Scholar 

  61. Pettaway CA, Pisters LL, Dinney CP, Jularbal F, Swanson DA, von Eschenbach AC, et al. Sentinel lymph node dissection for penile carcinoma: The M. D. Anderson Cancer Center experience. J Urol. 1995;154(6):1999–2003.

    Article  PubMed  CAS  Google Scholar 

  62. Morton DL, Wen DR, Wong JH, Economou JS, Cagle LA, Storm FK, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg. 1992;127(4):392–9.

    Article  PubMed  CAS  Google Scholar 

  63. Han KR, Brogle BN, Goydos J, Perrotti M, Cummings KB, Weiss RE. Lymphatic mapping and intraoperative lymphoscintigraphy for identifying the sentinel node in penile tumors. Urology. 2000;55(4):582–5.

    Article  PubMed  CAS  Google Scholar 

  64. Valdes Olmos RA, Tanis PJ, Hoefnagel CA, Jansen L, Nieweg OE, Meinhardt W, et al. Penile lymphoscintigraphy for sentinel node identification. Eur J Nucl Med. 2001;28(5):581–5.

    Article  PubMed  CAS  Google Scholar 

  65. Tanis PJ, Lont AP, Meinhardt W, Olmos RA, Nieweg OE, Horenblas S. Dynamic sentinel node biopsy for penile cancer: reliability of a staging technique. J Urol. 2002;168(1):76–80.

    Article  PubMed  CAS  Google Scholar 

  66. Kroon BK, Horenblas S, Meinhardt W, van der Poel HG, Bex A, van Tinteren H, et al. Dynamic sentinel node biopsy in penile carcinoma: evaluation of 10 years experience. Eur Urol. 2005;47(5):601–6. discussion 606.

    Article  PubMed  Google Scholar 

  67. Spiess PE, Izawa JI, Bassett R, Kedar D, Busby JE, Wong F, et al. Preoperative lymphoscintigraphy and dynamic sentinel node biopsy for staging penile cancer: results with pathological correlation. J Urol. 2007;177(6):2157–61.

    Article  PubMed  Google Scholar 

  68. Leijte JA, Hughes B, Graafland NM, Kroon BK, Olmos RA, Nieweg OE, et al. Two-center evaluation of dynamic sentinel node biopsy for squamous cell carcinoma of the penis. J Clin Oncol. 2009;27(20):3325–9.

    Article  PubMed  Google Scholar 

  69. Leijte JA, van der Ploeg IM, Valdes Olmos RA, Nieweg OE, Horenblas S. Visualization of tumor blockage and rerouting of lymphatic drainage in penile cancer patients by use of SPECT/CT. J Nucl Med. 2009;50(3):364–7.

    Article  PubMed  Google Scholar 

  70. Rippentrop JM, Joslyn SA, Konety BR. Squamous cell carcinoma of the penis: evaluation of data from the surveillance, epidemiology, and end results program. Cancer. 2004;101(6):1357–63.

    Article  PubMed  Google Scholar 

  71. Singh AK, Saokar A, Hahn PF, Harisinghani MG. Imaging of penile neoplasms. Radiographics. 2005;25(6):1629–38.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Urology, Massachusetts General Hospital, 55 Fruit St., Yawkey 7E, Boston, MA, 02114, USA

    Adam S. Feldman M.D., M.P.H. & W. Scott McDougal M.D.

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  1. Adam S. Feldman M.D., M.P.H.
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  2. W. Scott McDougal M.D.
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Correspondence to Adam S. Feldman M.D., M.P.H. .

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  1. Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, 33612, Florida, USA

    Philippe E. Spiess

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Feldman, A.S., McDougal, W.S. (2013). Evolving Imaging Modalities in the Diagnosis and Staging of Penile Cancer. In: Spiess, P. (eds) Penile Cancer. Current Clinical Urology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-62703-367-1_4

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  • DOI: https://doi.org/10.1007/978-1-62703-367-1_4

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