Assessment of the Pelvic Lymph Nodes

Metastases to the pelvic lymph nodes are found only in conjunction with the presence of inguinal metastases. Imaging in patients at high risk for pelvic metastasis may show pelvic lymphadenopathy, while assessment of the pelvic lymph nodes in the absence of inguinal nodal involvement is not indicated. Currently CT-scanning is not very accurate in predicting pelvic nodal involvement and has a sensitivity of only 20%.41 However, morphologically suspicious pelvic lymph nodes (defined as short-axis diameter more than 10 mm and/or central necrosis) in the presence of inguinal nodal involvement are malignant unless proven otherwise.41 The likelihood of pelvic involvement is also related to the number of positive inguinal lymph nodes and also the presence of extranodal extension in the inguinal specimen.4,22 Patients at high risk for pelvic metastasis may benefit from preoperative PET/CT-scanning.42 Although no direct comparison has been made between PET/CT-scanning and CT-imaging, PET/CT-scanning is likely to be more accurate in the preoperative staging of the pelvic lymph nodes. This is primarily based upon the experience in other malignancies.36-38 Additionally, distant metastasis can be identified with PET/ CT-scanning due to whole-body scanning. The use of other imaging modalities (e.g. MRI) to stage the pelvic lymph nodes in patients with penile carcinoma has not been fully evaluated.

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