PD53-04 IMAGE DIRECTED STRATIFICATION OF PATIENTS TO LYMPH NODE STAGING PROCEDURES IN PENILE CANCER IMPROVE OUTCOME? 10-YEAR STUDY IN >150 PATIENTS

Abstract

You have accessJournal of UrologyPenile & Testicular Cancer: Penile & Testicular Cancer II (PD53)1 Sep 2021PD53-04 IMAGE DIRECTED STRATIFICATION OF PATIENTS TO LYMPH NODE STAGING PROCEDURES IN PENILE CANCER IMPROVE OUTCOME? 10-YEAR STUDY IN >150 PATIENTS Prakrit Kumar, Arne Juette, Davina Pawaroo, Richard Ball, Krishna Sethia, and Vivekanandan Kumar Prakrit KumarPrakrit Kumar More articles by this author , Arne JuetteArne Juette More articles by this author , Davina PawarooDavina Pawaroo More articles by this author , Richard BallRichard Ball More articles by this author , Krishna SethiaKrishna Sethia More articles by this author , and Vivekanandan KumarVivekanandan Kumar More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002080.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Survival in penile cancer is largely determined by lymph node (LN) metastasis. Dynamic Sentinel Node Biopsy (DSNB) staging procedure has a false negative rate of 5-13%. We use image directed stratification patients to LN staging procedures as opposed to palpability and report the outcomes including survival. METHODS: 158 consecutive patients (316 inguinal basins (IB)), who had lymph node surgery for penile cancer in a tertiary referral centre from Jan 2008 to 2018, were included in the study. All patients underwent ultrasound (US) +/-fine needle aspiration cytology (FNAC) and then MRI/ CT, if needed to stage their disease. We used combined clinical and radiological criteria to stratify patients for DSNB vs inguinal lymph node dissection (ILND). RESULTS: 241 IBs had DSNB due to clinically node negative disease (cN0) and 71 IBs had ILND due to abnormal nodes (cN+) and 4 IBs were observed due to non-drainage in sentinel node scan. 27(11.2%), 39 (54.9%) and 0 of those had nodes positive for metastasis respectively. The minimum and mean follow-up is 28 and 65 months respectively. FNR is 0%. All the 25 bilateral ILND patients had cross-sectional imaging. 13 had CT, 11 had MRI and 1 had both. Of the 108 DSNB patients, 30 had MRI, 34 had CT, and one both. 43 patients who had normal ultrasound (U1-2) and impalpable nodes did not have any cross-sectional imaging. Interestingly, only 2/43 (4.7%) patients who did not have cross-sectional imaging were DSNB-positive for micro-metastatic disease as opposed to 14/64 (21.9%) of imaged patients (p=0.03). 11 IBs in 9 patients had ILND dictated by cross-sectional imaging despite having negative US+FNAC and impalpable nodes. 3 IBs in 3 patients had metastatic disease on which 2 had CT and one MRI. We believe these 3 cases could have become a false negative in palpability+US FNAC protocols. Mean cancer specific survival (CSS) of all node-positive patients was 105 months. There was a difference in OS depending on which staging investigation was done at the outset (i.e., DSNB vs ILND (108 vs 72 months, p<0.0001). Further pN+ patients identified by DSNB had no significant difference in CSS compared to direct ILND patients (89 vs 92 months, p=0.124). CONCLUSIONS: Our enhanced clinical-radiological stratification criteria eliminated FNR for DSNB. Cross sectional imaging further sub stratifies patients in to 3 risk categories for micro-metastasis. Node positive patients had poor OS compared to node negative patients. However there was no difference in CSS in pN+ patients if either DSNB or ILND is used. This is first report of survival in lymph node staging in penile cancer. Source of Funding: none © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e917-e917 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Prakrit Kumar More articles by this author Arne Juette More articles by this author Davina Pawaroo More articles by this author Richard Ball More articles by this author Krishna Sethia More articles by this author Vivekanandan Kumar More articles by this author Expand All Advertisement Loading ...