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Lymphoscintigraphy in penile cancer: limited value of sentinel node biopsy in patients with clinically suspicious lymph nodes

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Abstract

The staging lymph node dissection in patients with penile carcinoma is accompanied with a high morbidity. As many patients are free of nodal metastases the lymphoscintigraphic sentinel node biopsy is supposed to minimize perioperative morbidity in these patients. In the current study the accuracy of the lymphoscintigraphic sentinel node biopsy was verified against the gold standard of radical inguinal dissection. In particular, patients with enlarged lymph nodes have also been included since one half of these patients is known to have histologically negative lymph nodes. Between 2000 and 2004 fifteen patients with penile carcinoma were elected to undergo bilateral groin dissection, thus 30 inguinal areas have been dissected. Nine patients have had clinically palpable nodes. All patients underwent lymphoscintigraphy after injection of Tc99-nanocolloid subcutaneously into the peritumoral area. Intraoperatively the sentinel nodes were identified with the aid of a gamma ray detection probe and excised. Afterwards a standard groin dissection was performed and the different lymph nodes were histopathologically assessed separately. In all patients lymph nodes with high radioactivity uptake were detected bilaterally. In 10 out of 30 inguinal areas histopathologically positive lymph nodes were present. In four of them the sentinel node was positive for tumor but in six dissection areas lymph node metastases were found despite a negative sentinel node. These patients had clinically palpable lymph nodes in their histologically positive inguinal regions. If no palpable nodes were present dynamic sentinel biopsy detected the positive nodes. The current study showed that dynamic sentinel node biopsy in patients with clinically suspicious lymph nodes is of low value for detection of lymphatic spread in penile cancer. Therefore the gold standard in these patients remains the radical groin dissection. However, dynamic sentinel node biospy is still a promising strategy to identify lymphatic spreading in clinically N0 patients and therefore to prevent unnecessary groin dissection.

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References

  1. Skinner DG, Leadbetter WF, Kelley SB (1972) The surgical management of squamous cell carcinoma of the penis. J Urol 107:273–277

    PubMed  CAS  Google Scholar 

  2. Sufrin G., Huben R (1987) Benign and malignant lesions of the penis. In: Gillenwater JY, Grayhack JT, Howards SS (eds) Adult and pediatric urology. Chicago Year Book, Chicago, pp 1462–1473

    Google Scholar 

  3. Hussein AM, Benedetto P, Sridhar KS (1990) Chemotherapy with cisplatin and 5-fluorouracil for penile and urethral squamous cell carcinomas. Cancer 65:433–438

    Article  PubMed  CAS  Google Scholar 

  4. Persky L, deKernion J (1986) Carcinoma of the penis. CA Cancer J Clin 36:258–273

    Article  PubMed  CAS  Google Scholar 

  5. Horenblas S, van Tinteren H, Delemarre JF, Moonen LM, Lustig V, Kroger R (1991) Squamous cell carcinoma of the penis: accuracy of tumor, nodes and metastasis classification system, and role of lymphangiography, computerized tomography scan and fine needle aspiration cytology. J Urol 146:1279–1283

    PubMed  CAS  Google Scholar 

  6. Ornellas AA, Seixas AL, Marota A, Wisnescky A, Campos F, de Moraes JR (1994) Surgical treatment of invasive squamous cell carcinoma of the penis: retrospective analysis of 350 cases. J Urol 151:1244–1249

    PubMed  CAS  Google Scholar 

  7. Allen B, Campbell I, Desai S, Dray M, Scarlet J (2001) Pilot study comparing the accuracy of lymphoscintigraphy sentinel lymph node localisation with axillary node dissection in women with operable breast cancer. N Z Med J 114:233–236

    PubMed  CAS  Google Scholar 

  8. Statius Muller MG, van Leeuwen PAM, Borgstein PJ, Pijpers R, Meijer S (1999) The sentinel node procedure in cutaneous melanoma: an overview of 6 years’ experience. Eur J Nucl Med 26:20–25

    Google Scholar 

  9. Valdes Olmos RA, Tanis PJ, Hoefnagel CA, Jansen L, Nieweg OE, Meinhardt W, et al. (2001) Penile lymphoscintigraphy for sentinel node identification. Eur J Nucl Med 28:581–585

    Article  PubMed  CAS  Google Scholar 

  10. Lont AP, Horenblas S, Tanis PJ, Gallee MP, van Tinteren H, Nieweg OE (2003) Management of clinically node negative penile carcinoma: improved survival after the introduction of dynamic sentinel node biopsy. J Urol 170:783–786

    Article  PubMed  CAS  Google Scholar 

  11. Daeseler EH, Anson BH, Reimann AF (1948) Radical excision of the inguinal and iliac lymph glands: a study based upon 450 anatomical dissections and upon supportive clinical observations. Surg Gynecol Obstet 87:779

    Google Scholar 

  12. Scappini P, Piscioli F, Pusiol T, Hofstetter A, Rothenberger K, Luciani L (1986) Penile cancer. Aspiration biopsy cytology for staging. Cancer 58:1526–1533

    Article  PubMed  CAS  Google Scholar 

  13. Pizzocaro G, Piva L, Bandieramonte G, Tana S (1997) Up-to-date management of carcinoma of the penis. Eur Urol 32:5–15

    PubMed  CAS  Google Scholar 

  14. McDougal WS (1995) Carcinoma of the penis: improved survival by early regional lymphadenectomy based on the histological grade and depth of invasion of the primary lesion. J Urol 154:1364–1366

    Article  PubMed  CAS  Google Scholar 

  15. McDougal WS, Kirchner FK Jr, Edwards RH, Killion LT (1986) Treatment of carcinoma of the penis: the case for primary lymphadenectomy. J Urol 136:38–41

    PubMed  CAS  Google Scholar 

  16. Mobilio G, Ficarra V (2001) Genital treatment of penile carcinoma. Curr Opin Urol 11:299–304

    Article  PubMed  CAS  Google Scholar 

  17. Bouchot O, Rigaud J, Maillet F, Hetet JF, Karam G (2004) Morbidity of inguinal lymphadenectomy for invasive penile carcinoma. Eur Urol 45:761–765

    Article  PubMed  Google Scholar 

  18. Cabanas RM (1977) An approach for the treatment of penile carcinoma. Cancer 39:456–466

    Article  PubMed  CAS  Google Scholar 

  19. Perinetti E, Crane DB, Catalona WJ (1980) Unreliability of sentinel lymph node biopsy for staging penile carcinoma. J Urol 124:734–735

    PubMed  CAS  Google Scholar 

  20. Wespes E, Simon J, Schulman CC (1986) Cabanas approach: is sentinel node biopsy reliable for staging penile carcinoma? Urology 28:278–279

    Article  PubMed  CAS  Google Scholar 

  21. Pettaway CA, Pisters LL, Dinney CP, Jularbal F, Swanson DA, von Eschenbach AC, et al. (1995) Sentinel lymph node dissection for penile carcinoma: the M. D. Anderson Cancer Center experience. J Urol 154:1999–2003

    Article  PubMed  CAS  Google Scholar 

  22. Horenblas S, Jansen L, Meinhardt W, Hoefnagel CA, de Jong D, Nieweg OE (2000) Detection of occult metastasis in squamous cell carcinoma of the penis using a dynamic sentinel node procedure. J Urol 163:100–104

    Article  PubMed  CAS  Google Scholar 

  23. Wawroschek F, Vogt H, Bachter D, Weckermann D, Hamm M, Harzmann R (2000) First experience with gamma probe guided sentinel lymph node surgery in penile cancer. Urol Res 28:246–249

    Article  PubMed  CAS  Google Scholar 

  24. Akduman B, Fleshner NE, Ehrlich L, Klotz L (2001) Early experience in intermediate-risk penile cancer with sentinel node identification using the gamma probe. Urology 58:65–68

    Article  PubMed  CAS  Google Scholar 

  25. Pizzocaro G, Piva L, Nicolai N (1995) Improved management of of nodal metastase of squamous cell carcinoma of the penis. J Urol 153:246

    Google Scholar 

  26. Tanis PJ, Lont AP, Meinhardt W, Olmos RA, Nieweg OE, Horenblas S (2002) Dynamic sentinel node biopsy for penile cancer: reliability of a staging technique. J.Urol 168:76–80

    Article  PubMed  CAS  Google Scholar 

  27. Kroon BK, Horenblas S, Estourgie SH, Lont AP, Valdes Olmos RA, Nieweg OE (2004) How to avoid false-negative dynamic sentinel node procedures in penile carcinoma. J Urol 171:2191–2194

    Google Scholar 

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Acknowledgments

This study was supported by the Friedrich-Baur Stiftung (0085/2003).

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Correspondence to E. Hungerhuber.

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Hungerhuber, E., Schlenker, B., Frimberger, D. et al. Lymphoscintigraphy in penile cancer: limited value of sentinel node biopsy in patients with clinically suspicious lymph nodes. World J Urol 24, 319–324 (2006). https://doi.org/10.1007/s00345-006-0073-3

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  • DOI: https://doi.org/10.1007/s00345-006-0073-3

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