Dynamic Sentinel Node Biopsy in Penile Carcinoma: Evaluation of 10 Years Experience

Abstract

AbstractPurpose: The aim of this study was to evaluate the results of 10 years dynamic sentinel node biopsy experience inpenile carcinoma at our institute.Patients and Methods: 140 patients with clinically node-negative groins were prospectively included. Lymphos-cintigraphy was performed after injection of 99m Technetium-nanocolloid around the primary tumour. The sentinelnode was intraoperatively identified with the aid of patent blue dye and a gamma ray detection probe. Lymph nodedissection was performed only if sentinel node metastasis was found. Median follow-up was 52 months (range 5–129).Results: Lymphoscintigraphy visualized at least 1 sentinel node in 138 patients. Sentinel node metastasis was foundin 37 inguinal regions of 31 patients. The sentinel node was the only tumour-positive node in 78% (29/37) of thedissection specimens. Complications occurred in 8% (17/206) of the operated groins. False-negative results wereencountered in 6 patients resulting in a false-negative rate of 16% (6/37 patients). 5-year disease-specific survivalwas 96% and 66% for patients with a tumour-negative sentinel node and tumour-positive sentinel node, respectively(p = 0.001).Conclusion: Dynamic sentinel node biopsy in penile carcinoma is of important diagnostic, prognostic, andtherapeutic value at the cost of only minor morbidity.# 2004 Elsevier B.V. All rights reserved.Keywords: Penis; Penile neoplasms; Sentinel node biopsy; Lymph node excision; Lymphatic metastasis;Analysis; Survival1. IntroductionThe management of impalpable nodes in patientswith penile carcinoma has been subject of controversyfor many years and various approaches have been used.The most invasive approach is elective bilateral ingu-inal lymph node dissection, and the least invasive a‘‘wait and see’’ policy. A significant disadvantage ofthe former is the accompanying morbidity. Moreover itis considered unnecessary, as the regional lymph nodebasin is not tumour-affected in up to 80% of thepatients [1]. The disadvantage of a wait and seeapproach is a possible poorer prognosis at the timethat tumour involved lymph nodes become palpableduring follow-up [2,3]. Several investigators have triedto solve the problem by setting up selection criteria ofpatients in whom elective inguinal lymphadenectomyis indicated. Histopathological characteristics of theprimary tumour, such as depth of invasion (T-stage),