Incremental value of MRI for preoperative penile cancer staging.

Lucchesi, Fabiano Rubião; Reis, Rodoldo Borges; Faria, Eliney Ferreira; Machado, Roberto Dias; Rossini, Rodrigo Ribeiro; Borregales, Leonardo D.; Silva, Gyl Eanes Barros; Muglia, Valdair Francisco; Lucchesi, Fabiano Rubião

<bold>Purpose: </bold>To evaluate the incremental value of magnetic resonance imaging (MRI), compared to clinical examination, for penile cancer (PC) local staging.<bold>Materials and Methods: </bold>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.<bold>Results: </bold>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).<bold>Conclusion: </bold>According to our results, MRI improves local staging of PC patients, particularly for those with limited physical examination.<bold>Level Of Evidence: </bold>1 J. Magn. Reson. Imaging 2017;45:118-124.

CLINICAL trials; COMPARATIVE studies; MAGNETIC resonance imaging; RESEARCH methodology; MEDICAL cooperation; PREOPERATIVE care; PROGNOSIS; RESEARCH; RESEARCH evaluation; TUMOR classification; PENILE tumors; EVALUATION research

Journal of Magnetic Resonance Imaging, 2017, Vol 45, Issue 1, p118

1053-1807

Academic Journal

10.1002/jmri.25339