Diagnostic accuracy of dynamic sentinel lymph node biopsy for penile cancer in men with non-palpable and palpable inguinal lymph nodes
Lee, Esther Issa, Allaudin Oliveira, Pedro Lau, Maurice W Sangar, Vijay K Parnham, Arie S Fankhauser, Christian D
Lee, Esther
Issa, Allaudin
Oliveira, Pedro
Lau, Maurice W
Sangar, Vijay K
Parnham, Arie S
Fankhauser, Christian D
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Abstract
Introduction & Objectives: Penile cancer undergoes a stepwise dissemination and metastasises first to the inguinal lymph nodes (ILN). Because
men can be cured in this early stage of metastatic disease, early detection and treatment is important.
Materials & Methods: We performed a retrospective analysis of men with ≥T1G2 penile cancer and negative inguinal US guided FNA undergoing
DSNB. Men with suspicious US but negative FNA underwent US guided ILN excision. Men with ≥T1G2 local recurrence during follow-up and
non-squamous cell histologies were excluded. Descriptive analysis was performed, and sensitivity and negative predictive values (NPV) were
calculated.
Results: Of 1074 penile cancer treated between 2006-2020 a final cohort of 403 men with a median age of 65 years (interquartile range (IQR)
55-73) and body mass index (BMI) of 28.6 kg/m² (IQR 25-33) were included for this analysis. This gave 728 groins with negative FNA undergoing
DSNB +/- US guided lymph node excision. At least one sentinel node (SN) was visualised in 93% during the 1st and in 7% during the 2nd
lymphoscintigraphy. Median SNs visualised preoperatively was 1 and a median of 2 nodes were resected. ILN metastases were detected in
9% groins with non-palpable and in 17% with palpable lymph nodes. Stratified by non-palpable and palpable ILN, non-local recurrence despite
pathologically negative DSNBs was observed in 0.5% and 0%. Limited to men with at least 24 months follow-up, non-local recurrence after negative
DSNBs was observed in 0.4% and 0%. The sensitivity of DSNB was 96% and NPV was 100%. The main limitation of this analysis is its retrospective
nature with inherit biases.
Conclusions: Our results suggest that in a high volume centre pre-operative ultrasound +/- FNA and DSNB can be used to accurately stage
men with non-palpable and palpable ILN in men with ≥T1G2 penile cancer. Further, FNA in advance of surgery provides logistical and surgical
advantages. In those patients with palpable disease but negative FNA, we advocate ultrasound guided excision in case of enlarged or suspicious
ILN during DSNB
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Date
2022
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Meetings and Proceedings
Citation
Lee E, Issa A, Oliveira P, Lau M, Sangar V, Parnham M, et al. Diagnostic accuracy of dynamic sentinel lymph node biopsy for penile cancer in men with non-palpable and palpable inguinal lymph nodes. European Urology. 2022 Feb;81:S1016-S. PubMed PMID: WOS:000812320401079.