Diagnostic Performance of Preoperative Multiparametric MRI for Local and Nodal Staging in Penile Cancer: A Histopathology-Correlated Single-Centre Study

Abstract

Simple Summary Penile cancer treatment depends on tumour depth and lymph node involvement. Multiparametric magnetic resonance imaging (mpMRI) may supplement clinical staging, but histopathology-correlated evidence remains limited. We studied 38 men with penile cancer who underwent this MRI before definitive surgery; all tumours were glans-based, and all patients underwent organ-sparing treatment. MRI detected most tumours that were pathologically classified as ≥T2 but frequently overstaged tumours confined to ≤T1. In the 30 patients with complete pathological nodal verification, MRI showed encouraging performance for distinguishing N0 from N+ disease; the remaining eight patients were clinically node-negative and did not undergo invasive nodal staging because their primary tumours met EAU low-risk criteria. A post hoc two-reader analysis showed high inter-reader agreement. These findings support mpMRI as an adjunct in selected staging and surgical-planning dilemmas. MRI should not replace clinical examination, histopathology, dynamic sentinel node biopsy when indicated, or therapeutic lymphadenectomy.