Association between human papillomavirus status and the accuracy of [18F]-FDG PET/CT for detecting inguinal metastasis in penile cancer.

OBJECTIVES

[18F]-FDG positron emission tomography combined with computed tomography (PET/CT) allows the non-invasive assessment of inguinal lymph node (ILN) status in penile squamous cell carcinoma (PSCC). The aim of this study was to assess if the diagnostic accuracy of PET/CT was influenced by the human papillomavirus (HPV) status of the tumor.

METHODS

This retrospective study included 81 treatment-naïve patients with PSCC who underwent surgery between 2010 and 2024 and had a PET/CT before ILN surgery. Inguinal results were compared with histopathology (n = 72) or follow-up findings (n = 9), stratified by HPV status.

RESULTS

HPV DNA was detected in tumor tissue from 41 (51%) patients. The sensitivity and specificity of PET/CT to detect an ILN metastasis were 83% (69%-93%) and 68% (58%-76%), with no significant differences when stratified by HPV status (both P > 0.8). In multivariable logistic regression, after adjustment for the clinical nodal stage, the timing of PET/CT (before or after penile surgery), number of FDG-positive ILNs, the maximum standardized uptake value (SUVmax) of the ILNs and HPV status, SUVmax remained associated with ILN metastasis (OR 1.18, 95% CI: (1.05-1.38), P = 0.023). There was, however, no significant interaction between HPV status and SUVmax (P = 0.57).

CONCLUSIONS

The diagnostic accuracy of [18F]-FDG PET/CT regarding preoperative detection of ILN metastasis was not associated with the HPV status in penile cancer. These findings indicate that HPV status does not need to be considered when interpreting the inguinal findings of preoperative PET/CT scans.