Sentinel lymph node biopsy in penile cancer: a comparative study using modified inguinal dissection

Abstract

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.

Anatomic Aspects of Inguinal Lymph Nodes Applied to Lymphadenectomy in Penile Cancer

“…The reason for seeking new methods was to avoid overly extensive inguinal node dissections and related procedures. Complications of these techniques cause high rates of morbidity and death [19, 20], justifying the use of sentinel lymph-node dissection [21]. …”

A single-center comparison of our initial experiences in treating penile and urethral cancer with video-endoscopic inguinal lymphadenectomy (VEIL) and later experiences in melanoma cases

“…Moreover, only 10 published series employing VEIL have been published to date, and these just included 7-32 patients each (21). VEIL procedures are currently routinely performed in only 15 referral hospitals worldwide, as summarized in Table 1 (7,8,10,13,16,(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33).…”

“…Thus, less aggressive diagnostic procedures such as sentinel node biopsy ( 13 ) or modified limited lymphadenectomy are becoming more common substitutes. Moreover, because of a lack of experience and fear of the risk of complications, penile cancer patients are sometimes not histologically staged at all and are wrongly managed with surveillance only.…”

Video Endoscopic Inguinal Lymphadenectomy (VEIL): Minimally Invasive Radical Inguinal Lymphadenectomy Technique

“…Radical inguinal lymphadenectomy provides local control of disease and has a survival advantage but is a morbid procedure. Attempts have been made to reduce the morbidity by modifying the template, technique and to preserve the saphenous vein [6][7][8]. Despite of careful dissection and maintaining vascularity to skin, and refinement of techniques, necrosis of the margins, lymphorrhea and other surgical morbidity is seen in upto 50 % of patients [9][10][11].…”