Should the Dynamic Sentinel Node Biopsy (DSNB) be Considered the Gold Standard in the Evaluation of Lymph Node Status in Patients with Penile Carcinoma?

Abstract

The presence and extension of inguinal and pelvic lymph node metastases are the most relevant prognostic factors in squamous cell carcinoma of the penis. At the same time, the correct indication, timing, and surgical extension of inguinal and iliac lymph node dissection (LND) represent the cornerstones of the therapy of this rare cancer. Among the clinical information available at the initial diagnosis, the clinical stage of groin lymph nodes has been documented to be the most important one to predict the pathologic involvement of inguinal lymph nodes [1]. At the initial presentation, clinically palpable inguinal lymph nodes are present in 28–64% of patients with penile carcinoma. In 47–85% of these patients, metastatic inguinal lymph nodal involvement is histologically proven. In the remaining patients, groin lymph node enlargement is due to overlapping inflammatory reactions caused by infection of the primary tumour. In this category of patients, the European Association of Urology (EAU) recommends to perform fineneedle aspiration cytology to confirm the neoplastic involvement of the palpable nodes [2]. In patients with nonpalpable inguinal lymph nodes, occult micrometastases are present in 12– 24% of cases. In these patients, early LND significantly improves the 3-yr cancer-specific survival [3]. However, the therapeutic benefits of early inguinal