Dynamic Sentinel Node Biopsy for Inguinal Lymph Node Staging in Patients with Penile Cancer: A Systematic Review and Cumulative Analysis of the Literature

Neto, Ary Serpa; Tobias-Machado, Marcos; Ficarra, Vincenzo; Wroclawski, Marcelo Langer; Amarante, Rodrigo Dal Moro; Pompeo, Antônio Carlos Lima; Giglio, Auro del

doi:10.1245/s10434-010-1546-6

Cited by 37 publications

(17 citation statements)

References 39 publications

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“…Leijte et al were able to decrease the complication rate of inguinal DSNB from 10.2 to 5.7 % [ 7 ]. In a systemic review, Neto et al reported a complication rate of 3.6 % when performing inguinal DSNB [ 31 ]. However, inguinal LND is a procedure with a considerably higher complication rate of 40–50 % [ 23 , 31 ].…”

Section: Discussionmentioning

confidence: 99%

Reliability of radioisotope-guided sentinel lymph node biopsy in penile cancer: verification in consideration of the European guidelines

et al. 2015

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BackgroundLymph node (LN) staging in penile cancer has strong prognostic implications. This contrasts with the high morbidity of extended inguinal LN dissection (LND) or over-treatment of many patients. Therefore, inguinal dynamic sentinel node biopsy (DSNB) or modified LND is recommended by the European Association of Urology (EAU) guidelines to evaluate the nodal status of patients with clinically node-negative penile cancer. This study analyzed the reliability and morbidity of radioguided DSNB in penile cancer under consideration of the current EAU recommendations in an experienced center with long-term follow-up.MethodsThirty-four patients who received primary surgery and had radioguided inguinal DSNB for penile cancer (≥T1G2) were included (July 2004 to July 2013). Preoperative sentinel LN (SLN) mapping was performed using lymphoscintigraphy after peritumoral injection of 99mTechnetium nanocolloid on the day of surgery. During surgery, SLNs were detected using a gamma probe. According to the EAU guidelines, a secondary ipsilateral radical inguinal LND was performed in patients who had positive SLNs. The false-negative and complication rates of DSNB were assessed.ResultsA total of 32 patients were analyzed. Two patients were lost to follow-up. A total of 166 SLNs (median, 5; range, 1–15) were removed and 216 LNs (SLNs + non-SLNs; median, 6; range, 2–19) were dissected. LN metastases were found in five of the 32 (15.6 %) patients and nine of the 166 (5.4 %) SLNs were found to contain metastases. None of the remaining 50 non-SLNs contained metastases. In only one of the five SLN-positive patients, a singular further metastasis was detected by secondary radical inguinal LND. During follow-up (median, 30.5; range, 5–95 months) no inguinal nodal recurrence was detected. DSNB-related complications occurred in 11.1 % of explored groins.Discussion and ConclusionsRadioguided DSNB is a suitable procedure for LN staging in penile cancer considering the EAU recommendations and with the required experience. Under these circumstances, patients can be spared from higher morbidity without compromising the detection of LN metastases or therapeutic implications. Improvement of the methodology used to perform DSNB should be developed further to decrease the risk of missing LN metastases and to simplify the procedure.

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Section: Discussionmentioning

confidence: 99%

Reliability of radioisotope-guided sentinel lymph node biopsy in penile cancer: verification in consideration of the European guidelines

et al. 2015

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“…A review in penile cancer of 10 studies published in 2011 showed a 3.5% FN rate for the SN biopsy. 57 In melanoma patients, a FN rate of 11% was noted, 58 and higher rates were described in patients treated with neoadjuvant chemotherapy for breast cancer. 59 The FN rate, however, could be reduced by implementing immunohistochemistry.…”

Section: Causes Of Fn Sn Proceduresmentioning

confidence: 99%

Advances in sentinel node dissection in prostate cancer from a technical perspective

et al. 2015

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Abbreviations & Acronyms ePLND = extended pelvic lymph node dissection FN = false negative ICG = indocyanine green LN = lymph node MRI = magnetic resonance imaging NIR = near-infrared NR = not reported PCa = prostate cancer PET = positron emission tomography PLND = pelvic lymph node dissection SN = sentinel node SPECT-CT = single-photon emission computed tomography combined with computed tomography TRUS = transrectal ultrasound Abstract: The most important feature of sentinel node biopsy for prostate cancer procedure is that staging can be improved. Sentinel nodes might be found outside the extended pelvic lymph node dissection template what renders the sentinel node additive of extended pelvic lymph node dissection. At the same time, staging within the template can be further refined. We reviewed the literature regarding the sentinel node biopsy procedure for prostate cancer. PubMed and Embase were searched for all Englishlanguage publications from January 1999 to September 2014 by using the keywords as "prostate cancer" and "sentinel lymph node" plus "biopsy" "dissection" and/or "procedure." The present review discusses step-by-step sentinel node biopsy for prostate cancer. Topics of discussion are: (i) preoperative sentinel node mapping (tracers and imaging); (ii) intraoperative sentinel node identification (surgical procedure and outcome); and (iii) novelties to improve sentinel node identification (pre-and intraoperative approaches). Conventional sentinel node mapping is carried out after the injection of a 99m Tc-based tracer and subsequent preoperative imaging; for example, lymphoscintigraphy and singlephoton emission computed tomography/computed tomography. This approach allowed the detection of sentinel nodes outside the extended lymph node dissection template in 3.6-36% of men with intermediate-and high-risk prostate cancer. Hereby, an overall false negative rate of sentinel nodes was reported between 0% and 24.4%. To further refine the intraoperative sampling procedure, novel imaging methods such as fluorescence imaging have been introduced. Prospective randomized comparison studies are required to confirm the added benefit of sentinel template directed nodal dissection. A proper and obtainable end-point of such a study could be the number of removed positive nodes for carrying out nodal dissection with or without sentinel template directed dissection. Similarly, the clinical impact of novel imaging technologies requires further investigation.

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“…Using fine-needle aspiration (FNA) and ultrasonography, as well as real-time pathological sectioning and immunohistochemical staining of suspected specimens, DSNB can identify metastasis 42 mm in diameter. 35 If the results of the FNA are negative, an excisional biopsy may be warranted based on the clinical suspicion of nodal involvement. Using this technology, the sensitivity of the DSNB technique can be as high as 90% across experienced centers where at least 20 procedures are performed per year.…”

Section: Surgical Treatment Of T2-t4 Diseasementioning

confidence: 99%

Current surgical management of penile cancer

Zargar‐Shoshtari¹,

Spiess²

2015

Current Problems in Cancer

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Dynamic Sentinel Node Biopsy for Inguinal Lymph Node Staging in Patients with Penile Cancer: A Systematic Review and Cumulative Analysis of the Literature

Abstract: The use of dynamic sentinel lymph node biopsy to detect lymph node metastasis in specialized centers appears to be justified. Addiction of other techniques to DSNB to reduce false-negative results is awaited and must be confirmed by future studies.

Cited by 37 publications

References 39 publications

Reliability of radioisotope-guided sentinel lymph node biopsy in penile cancer: verification in consideration of the European guidelines

Reliability of radioisotope-guided sentinel lymph node biopsy in penile cancer: verification in consideration of the European guidelines

Advances in sentinel node dissection in prostate cancer from a technical perspective

Current surgical management of penile cancer

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