Introduction: In the case of clinically negative inguinal regions in penile cancer, the treatments proposed might vary from careful observation to radical dissection for all patients. We evaluated the effectiveness of the sentinel lymph node biopsy using lymphoscintigraphy in patients with penile cancer and at least one negative inguinal region. Materials and Methods:In 18 patients, biopsy of the sentinel lymph node from the 32 negative inguinal regions and modified radical lymphadenectomy in these regions regardless of the biopsy results was performed. Clinical staging, pathological results of the sentinel and the other lymph nodes removed during lymphadenectomy, tumor behavior, local and inguinal recurrence and specific disease mortality were accessed. Results: The mean age of the study sample was 57.7 years (44 -81 years) and the sentinel lymph node presented 0% false negative 66% sensitivity, and 79.3% specificity when compared with the modified inguinal lymphadenectomy as the gold standard treatment. Conclusion: Sentinel lymph node biopsy is a feasible method of assessing the presence of regional metastasis in patients with penile cancer and clinically negative inguinal regions. However, the optimal lymphoscintigraphy technique is still in evolution and requires further optimization at high volume centers.
Penile cancer is a rare condition that is potentially cured by tumor excision and regional lymphadenectomy. Considering the great morbidity and mortality associated to inguinal lymphadenectomy, its indication is still controversial.We designed a prospective study to evaluate the accuracy of dynamic sentinel node biopsy in the detection of occult inguinal metastasis.From august 1999 to september 2004, seventeen consecutive patients with invasive squamous cell carcinoma of the penis and clinically node negative disease were prospectively entered in this study. A total of 13 patients had bilateral and 4 unilateral clinically node negative disease. All patients underwent lymphoscintigraphy with 99mTechnetium fitate injected intradermally in 4 points around the primary tumor two hours before the operation to locate the sentinel node. After obtaining dynamic images of the tracer distribution using a gamma camera, the sentinel node was identified intraoperatively by a gamma ray detection probe and then excised. Inguinal lymph node dissection was also performed bilaterally in all of the patients. The hystopathological result of the sentinel node was compared to the hystopathological result of the regional lymphadenectomy.Patients were seen at regular outpatient visits, with a mean follow-up of 20 months (range 2 to 54 months).Tumor stage was pT1 in 5 patients, pT2 in 11 and pT3 in 1. The differentiation grade was I in 13 patients, grade II in 3 and grade III in 1. Sentinel nodes from 25 inguinal regions of 17 patients were resected, all nodes were identified by scintigraphy and by the gamma ray detection probe. Five inguinal regions of 5 patients showed no sentinel node. Scintigraphy revealed bilateral drainage in 9 patients, unilateral in 4. One patient of 4 with unilateral clinical stage N1 disease had a tumor positive sentinel node at the clinically node negative side and other did not show any sentinel node at all. Sentinel node metastasis was found in 2 inguinal regions of 2 patients. Three regional lymphadenectomies of 2 patients showed metastasis, 2 corresponding to the tumor positive sentinel nodes and 1 from a groin that no sentinel node was found. No metastasis was found in inguinal regions with a tumor free sentinel node.
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