Radiocolloid-based dynamic sentinel lymph node biopsy in penile cancer with clinically negative inguinal lymph node: an updated systematic review and meta-analysis

Zou, Zhen; Liu, Zhihong; Tang, Liang-you; Wang, Yujie; Liang, Jiayu; Zhang, Ruo-cheng; Tang, Yefeng; Lu, Yiping

doi:10.1007/s11255-016-1405-x

Cited by 44 publications

(18 citation statements)

References 42 publications

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“…• (diagnostic) modified inguinal lymph node dissection. For DSNB, high micrometastasis detection rates (sensitivity approximately 90-95%) along with rates of false-negative results of 5 to 10% as well as low morbidity have been described (28).…”

Section: Non-enlarged (Non-palpable) Inguinal Lymph Nodesmentioning

confidence: 99%

The Diagnosis and Treatment of Penile Cancer

Hakenberg¹,

Dräger²,

Erbersdobler³

et al. 2018

Deutsches Ärzteblatt International

105

133

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enile cancer is an aggressive squamous cell carcinoma of the skin of the glans or of the inner layer of the prepuce, characterized by invasive growth and early metastatic spread to lymph nodes. While penile cancer is uncommon in Europe, incidence rates are very high in parts of South America and Africa. Since its treatment is often associated with significant cosmetic and functional defects, the disease is of critical importance to the affected men. Early metastatic spread to regional lymph nodes can be life-threatening. It is not uncommon that factors, both from the patient and the treating physician, are causing delays in diagnosis and start of treatment. With penile cancer being a comparatively rare disease, many physicians are unfamiliar with its management. Thus, several countries have centralized the treatment of this rare tumor. Penile cancer is an orphan disease. Due the low numbers of patients, no prospective randomized studies have become available. Most of the available data is from small retrospective studies; larger studies result from retrospective multicenter data collections. Thus, the level Summary Background: The incidence of penile cancer in Europe lies in the range of 0.9 to 2.1 cases per 100 000 persons per year. Carcinogenesis is associated with human papilloma virus (HPV) infection and with chronic inflammation. Methods: This review is based on publications (2010-2017) retrieved by a selective search in PubMed and EMBASE and on the guidelines of the European Association of Urology, the European Society of Medical Oncology, the National Comprehensive Cancer Network, and the National Institute for Health and Care Excellence (NICE). Results: 95% of cases of penile cancer are accounted for by squamous cell carcinoma, whose numerous subtypes have different clinical courses. Chronic preputial inflammation due to phimosis or lichen sclerosus is often associated with penile cancer. Circumcision lowers the risk of penile cancer (hazard ratio: 0.33). Maximally organ-preserving surgery with safety margins of no more than a few millimeters is the current therapeutic standard, because a local recurrence, if it arises, can still be treated locally with curative intent. Local radiotherapy can be performed in early stages. Lymphogenic metastasis must be treated with radical lymphadenectomy and adjuvant chemotherapy. Patients with clinically unremarkable inguinal lymph nodes nonetheless need invasive lymph node staging because of the high rate of lymphogenic micrometastasis. Conclusion: Penile cancer is curable in all early stages with the appropriate treatment, but its prognosis depends crucially on the proper management of the regional (i.e., inguinal) lymph nodes. In many countries, the treatment of this rare disease entity has been centralized.

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Section: Non-enlarged (Non-palpable) Inguinal Lymph Nodesmentioning

confidence: 99%

The Diagnosis and Treatment of Penile Cancer

Hakenberg¹,

Dräger²,

Erbersdobler³

et al. 2018

Deutsches Ärzteblatt International

105

133

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“…SLNB can be offered to patients diagnosed with penile cancer with intermediate and high risk of lymph node metastasis and Stage cN0 of the disease. [17] This technique was accepted as an option for patients with undetected lymph node metastasis and is recommended for patients with nonpalpable lymph nodes, according to Horenblas et al [18] However, there are a lot of issues that have kept away this procedure from routine use, the main obstacle is the high false-negative rate reported in the initial studies: Horenblas et al , Gonzana-Silva et al , and Pettaway et al , all of which indicate a rate of 12%–25%. [19] This is possibly due to the difficulty in the identification of lymph nodes based on the anatomic location, the absence of physiological identification, and the inadequate histopathological analysis.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic precision of sentinel lymph node biopsy in penile cancer

et al. 2019

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Introduction:Sentinel lymph node biopsy (SLNB) was designed as a minimally invasive method for evaluation of nodal involvement in patients with penile cancer and nonpalpable lymph nodes. Nevertheless, SLNB is not used in a regular basis due to the lack of studies that adequately characterize the performance of this procedure. The purpose of this study was to evaluate the diagnostic performance of SLNB in patients with infiltrative penile carcinoma without palpable inguinal lymph nodes in a Colombian population.Materials and Methods:This is a retrospective observational study of 89 patients diagnosed with infiltrative penile squamous cell carcinoma with nonpalpable inguinal lymph nodes. These patients underwent partial or complete penectomy, along with SLNB, between 2008 and 2017. Those individuals with a positive SLNB underwent inguinal lymphadenectomy, while those with a negative SLNB were followed on a quarterly basis with a physical examination and imaging to assess relapse. Statistical analysis was done using the STATA 14 software. A contingency table was made to calculate sensitivity, specificity, positive predictive value, negative predictive value, and exactitude, each one with its own confidence interval (CI) of 95%.Results:There was an average follow-up of 31.4 months, and all 89 patients were evaluated; most primary tumors were T2 (55%), followed by T1 (37%), all of which were subclassified as T1b and T3 (8%). Tumours were most frequently located in the glans (43%). All patients were classified as cN0 and underwent SLNB. Sixty-one patients (69%) tested negative in the SLNB, four of whom (6%) presented with lymph node relapse. On the other hand, 28 patients (31%) tested positive in the SLNB and consequently underwent inguinal lymphadenectomy, seven of whom had negative lymph nodeinvolvement (25% false positives). According to the results, the sensitivity was 84% (95% CI, 65.3–93.6) and the specificity was 89% (95% CI, 79.4–94.7), with a false-negative rate of 6.5%.Conclusions:The SLNB using radiotracer can be a useful method for lymph node staging in patients with penile cancer and nonpalpable lymph nodes when performed in experienced centers.

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“…Invasive lymph node staging (pN) was recommended for patients with no palpable inguinal nodes (cN0), but pT1 tumors of intermediate and high risk (≥ pT1G2), as well as for T2-T4 tumors by either dynamic sentinel-node biopsy (DSNB) ( Fig. 1) or by modified inguinal lymphadenectomy (miLAD), [5,20]. Radical inguinal lymphadenectomy (rLAD) was performed in patients with palpable inguinal lymph nodes (cN1/N2) at primary diagnosis, and in those with a positive lymph node status after invasive nodal staging [5].…”

Section: Patients and Pathological Stagingmentioning

confidence: 99%

Organ-sparing surgery of penile cancer: higher rate of local recurrence yet no impact on overall survival

et al. 2019

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Purpose To report on the oncological outcome of organ-sparing surgery (OSS) compared to (total or partial) penectomy regarding recurrence patterns and survival in squamous cell carcinoma (SCC) of the penis. Methods This was a retrospective study of all patients with penile SCC and eligible follow-up data of at least 2 years at our institution. Patients with tumors staged ≥ pT1G2 underwent invasive lymph node (LN) staging by dynamic sentinel-node biopsy or modified inguinal lymphadenectomy. Radical inguinal lymphadenectomy was performed when LNs were palpable at diagnosis and in those with a positive LN status after invasive nodal staging. Follow-up visits were assessed, and local, regional and distant recurrences were defined and analyzed. Results 55 patients were identified with a mean follow-up of 63.7 months. Surgical management was OSS in 26 patients (47.2%) and partial or total penectomy in 29 cases (52.8%). Histopathological staging was: pTis (12.7%), pTa (16.3%), pT1a (18.2%), pT1b (5.5%), pT2 (29.1%) and pT3 (18.2%), respectively. Patients in the penectomy group were significantly older (mean 68 vs. 62 years; p = 0.026) with a higher rate of advanced tumor stage (≥ pT2: 44.8% vs. 11.5%; p = 0.002). The local recurrence rate was 42.3% (n = 11) following OSS compared to 10.3% (n = 3) after penectomy (p = 0.007). Kaplan-Meier curves showed no significant differences between the two groups regarding metastasis-free and overall survival. Conclusions OSS is associated with a higher local recurrence rate compared to penectomy, yet it has no negative impact on overall and metastasis-free survival.

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Radiocolloid-based dynamic sentinel lymph node biopsy in penile cancer with clinically negative inguinal lymph node: an updated systematic review and meta-analysis

Cited by 44 publications

References 42 publications

The Diagnosis and Treatment of Penile Cancer

The Diagnosis and Treatment of Penile Cancer

Diagnostic precision of sentinel lymph node biopsy in penile cancer

Organ-sparing surgery of penile cancer: higher rate of local recurrence yet no impact on overall survival

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