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Feasibility of performing dynamic sentinel lymph node biopsy as a delayed procedure in penile cancer

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Abstract

Introduction

Patients diagnosed with penile cancer and clinically impalpable inguinal lymph nodes (cN0), normally undergo dynamic sentinel lymph node biopsy (DSNB) at the same time as the primary penile surgery. The aim of this study is to investigate the diagnostic accuracy and clinical outcomes of performing DSNB in patients who have already undergone surgery for the primary penile cancer.

Methods

Ninety-two patients with unilateral or bilateral impalpable inguinal lymph nodes (LNs) who had already undergone primary resection of the penile tumour (stage ≥ T1G2) were included in this study. All patients underwent a preoperative USS of the groin(s) with fine needle aspiration cytology (FNAC). Provided that the FNAC was clear, DSNB was performed. Radical inguinal lymphadenectomy was performed if the histological analysis of the SLN confirmed the presence of micrometastatic disease.

Results

DSNB was undertaken in 165 groins with a nonvisualisation rate of 4.8 % (8/165 groins). The SLN was positive for micrometastatic disease in nine groins (5.5 %) from a total of eight patients (8.7 %). One patient developed regional recurrence in a prepubic LN after excision of bilateral negative SLN (1.1 %). The three-year disease-specific survival for patients with negative and positive SLN was 98.8 and 87.5 %, respectively (p = 0.042). Using DSNB, occult LN metastases in penile cancer can be detected with a sensitivity of 88.9 % and specificity of 100 %.

Conclusions

We have demonstrated that DSNB is feasible as a delayed procedure to localise the SLN. Surgical resection of the primary penile lesion does not appear to change the lymphatic drainage.

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Conflict of interest

There are no conflicts of interest disclosed by the authors related to this study.

Ethical standard

This is a registered prospective audit for a procedure which is a standard of care for patients within the institution and complies with the institutional ethics for data collection.

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Authors and Affiliations

  1. Department of Urology, University College Hospital, London, UK

    Savvas Omorphos, Manit Arya, Peter Malone, Raj Nigam & Asif Muneer

  2. Institute of Nuclear Medicine, University College Hospital, London, UK

    Zia Saad & Jamshed Bomanji

  3. Department of Pathology, University College Hospital, London, UK

    Alex Freeman

Authors
  1. Savvas Omorphos
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  2. Zia Saad
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  3. Manit Arya
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  4. Alex Freeman
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  5. Peter Malone
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  6. Raj Nigam
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  7. Jamshed Bomanji
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  8. Asif Muneer
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Corresponding author

Correspondence to Asif Muneer.

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Omorphos, S., Saad, Z., Arya, M. et al. Feasibility of performing dynamic sentinel lymph node biopsy as a delayed procedure in penile cancer. World J Urol 34, 329–335 (2016). https://doi.org/10.1007/s00345-015-1577-5

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  • DOI: https://doi.org/10.1007/s00345-015-1577-5

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