Predicting inguinal metastases in cancer penis

Abstract

Objective: Is it possible to predict inguinal metastasis in penile cancer? Materials and Methods: This is a retrospective analysis of 90 cases of squamous cell carcinoma of penis. The analysis involved a study of archival specimens by a single consultant pathologist. The grade and depth of invasion of the primary tumor was studied. We tried to establish a correlation with clinical positivity as determined by physical examination, grade of primary tumor, depth of invasion and inguinal lymph node metastasis. Results: Metastatic status was known in 44 of 64 patients with clinically palpable inguinal nodes and 18 of 26 with clinically negative nodes. Of 62, 27 had lymph node metastasis in which 16 were poorly differentiated primary tumor. Inguinal lymph node metastasis was seen in six of nine (66.66%) when depth of invasion was more than 8 mm. Conclusions: In well-differentiated tumors with less than 3mm depth of invasion, active surveillance of the node could be recommended. In the rest, it may be wise in our country to offer prophylactic modified inguinal lymphadenectomy to avoid progression of disease from loss to follow-up. Morbidity can be reduced with a modified inguinal lymph node dissection in a majority and also by using principles of plastic surgery in the remainder.