Abstract
Imaging modalities using tumor-directed monoclonal antibodies may be of value to improve the pre- and intraoperative detection and resection of lymph node (LN) metastatic disease in penile squamous cell carcinoma (PSCC). We investigated the expression of prostate-specific membrane antigen (PSMA), vascular endothelial growth factor (VEGF), epidermal growth factor receptor (EGFR) and epithelial cell adhesion molecule (EpCAM) to analyze their potency for diagnostic applications. Antigen expression was determined in primary tumors and LNs with and without metastases of 22 patients with PSCC. The total immunostaining score (TIS, 0–12) was determined as the product of a proportion score (PS, 0–4) and an intensity score (IS, 0–3). EGFR and VEGF expression were high in primary tumor (median TIS 8) and LN metastases (median TIS 6 and 8, respectively). No EGFR expression was seen in LNs without metastases. However, LNs without metastases did show VEGF expression (median TIS 6). No EpCAM or PSMA expression was seen in PSCC. This study shows that VEGF and EGFR expression is moderate to high in LN metastases of PSCC. Both VEGF and EGFR warrant further clinical evaluation to determine their value as a target for pre- and intraoperative imaging modalities in the detection of LN metastases in PSCC.
Highlights
Radical resection of lymph node (LN) metastases in patients with penile squamous cell carcinoma (PSCC) is paramount, since this is the only treatment to cure patients with lymph node positive disease [1]
prostate-specific membrane antigen (PSMA) and epithelial cell adhesion molecule (EpCAM) appeared as imaging targets for PSCC because the negative staining results of these antigens in primary tumors not to be usable as imaging targets for PSCC because the negative staining results of these antigens as well as positive LNs
epidermal growth factor receptor (EGFR) is overexpressed in prostate cancer, in 31–48% of bladder cancer and 25–77% of colon and rectal cancer as well [33], which might reduce the specificity for the detection of PSCC by using imaging modalities with antibodies directed against EGFR
Summary
Radical resection of lymph node (LN) metastases in patients with penile squamous cell carcinoma (PSCC) is paramount, since this is the only treatment to cure patients with lymph node positive disease [1]. The monoclonal antibodies prostate-specific membrane antigen (PSMA), vascular endothelial growth factor (VEGF). Diagnostics 2020, 10, 694 and epidermal growth factor receptor (EGFR) have already been used as imaging agents for molecular imaging in various tumors. Squamous cell carcinomas of the head and neck showed a high expression of epidermal growth factor receptor (EGFR) [8]. Both VEGF and EGFR have been used as a radiolabeled imaging agent for molecular imaging in the previously mentioned tumors [9,10]. We investigated the expression of PSMA, VEGF, EGFR and EpCAM using immunohistochemistry in LN metastatic disease of PSCC
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