Valor do 18F-FDG/CT no estadiamento do câncer de pênis

Abstract

Penile cancer (PC) is a rare neoplasm in Western developed countries, however, in developing regions, its incidence can be high. In Brazil, according to the Brazilian National Cancer Institute (INCA), PC represents up to 2% of cancers in men, reaching 17% in the North and Northeast regions. Thus, the PC in Brazil can be seen as a public health issue, with one of the highest incidences of this disease worldwide. The dilemmain the treatment of penile cancer is the correct assessment and approach to regional inguinal nodes. This assessment is of utmost importance as directly impacts the prognosis and the possibility of curing the disease. Clinical staging of the inguinal region is flawed and confuse mainly due to enlarged lymph nodes secondary to the tumor inflammation. Morphological imaging techniques has also conflicting results,while the use of 18F-FDG PET/CT has shown promising results. The objective of this study was to investigate the role of 18F-FDG PET/CT in the staging of patients with penile cancer confirmed histopathologically and referred to surgery. The sample consisted of 55 patients with histological diagnosis of PC, which were submitted to 18FFDG PET/CT before surgery. Epidemiological, surgical and follow up data were compared with the semiquantitative values from PET/CT using different statistical methods. It was demonstrated that the PC involved patients in the sixth decade of life, with low socio-educational level, with phimosis in 32.1% of cases and smokers in 56.6%. In clinical staging, 45.5% had cN (+). Associating the data from the clinical staging and pathological results of the primary tumors, lymphadenectomy was indicated in 30 patients which about 45.6% were positive pN (+). The PET/CT was shown to bean important tool in the characterization of cN (+) patients, with a diagnostic accuracy of 81%. Similar findings were observed in patients who had tumor affecting deep structures of the penis (pT 2-4). Regarding the clinical course and overall patients survival, PET/CT was a important tool to stratify patients that had better clinical outcome and survival. This study demonstrates that PET/CT with 18F-FDG can be used in the evaluation of lymph node involvement in cN(+) patients, and indicate thepossibility of penile tumor invasion and characterization of clinical outcome and overall survival.