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Value and efficiency of sentinel lymph node diagnostics in patients with penile carcinoma with palpable inguinal lymph nodes as a new multimodal, minimally invasive approach

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

The international guidelines recommend sentinel lymph node biopsy (SLNB) for lymph node staging in penile cancer with non-palpable inguinal lymph nodes (LN) but it is not recommended with palpable inguinal LN. The aim of this study was to evaluate the reliability and morbidity of SLNB in combination with an ultrasound-guided resection of suspect inguinal LNs as a new multimodal, minimally invasive staging approach in these patients.

Methods

We performed SLNB in 26 penile cancer patients with 42 palpable inguinal LNs. Prior to the combined staging procedures the patients underwent an ultrasound examination of the groins as well as planar lymphatic drainage scintigraphy and SPECT/CT scans. During the surgical procedure, the radioactive-labelled sentinel lymph nodes and, in addition, sonographically suspect LNs, were resected under ultrasound guidance. Follow-up screening was done by ultrasound examination of the groins according to the guidelines of the European Association of Urology.

Results

Nineteen groins of 42 preoperatively palpable inguinal findings were histologically tumor-positive. SLNB alone showed lymphogenic metastases in 14 groins. Sonography revealed five further metastatic groins, which would not have been detected during SLNB due to a tumor-related blockage of lymphatic drainage or a so-called re-routing of the tracer. During follow-up, none of the 28 groins with tumor-negative LN status showed any LN recurrence in this combined investigation technique. The median follow-up period was 46 (24 to 92) months. Morbidity of this procedure was low at 4.76 % in relation to the number of groins resp. 7.69 % in relation to the number of patients.

Conclusions

The results show that this combined procedure is a reliable multimodal diagnostic approach for treatment of penile cancer patients with palpable inguinal LNs. It is associated with low morbidity rates. SLNB alone would lead to a significantly higher false-negative rate in these patients. The encouraging results of this work can extend the range of indications for nuclear medicine in the form of SLNB using radioactive tracers in this patient group.

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Acknowledgments

We thank Ms. Almut Kalz for proof-reading and editing the manuscript, as well as Mr. Felix Prell and Mr. Bernhard Egeler for the design of graphical representations.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Molecular Imaging Diagnostics and Therapy, University Hospital Schleswig Holstein, Campus Kiel, Feldstr. 21 (Haus 50), D-24105, Kiel, Germany

    Ulf Lützen, Maaz Zuhayra, Marlies Marx & Yi Zhao

  2. Department of Urology and Pediatric Urology, University Hospital Schleswig Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 18, D-24105, Kiel, Germany

    Christian Colberg, Stephanie Knüpfer, Klaus-Peter Jünemann & Carsten Maik Naumann

  3. Department of Radio Oncology, University Hospital Schleswig Holstein, Campus Kiel, Feldstr. 21 (Haus 50), D-24105, Kiel, Germany

    René Baumann

  4. Department of Dermatology, Venerology and Allergology, University Hospital Schleswig Holstein, Campus Kiel, Schittenhelmstr. 7, D-24105, Kiel, Germany

    Katharina Charlotte Kähler

Authors
  1. Ulf Lützen
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  2. Maaz Zuhayra
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Correspondence to Ulf Lützen.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Ethics Committee of the Christian-Albrechts-University of Kiel (Az. D426/07).

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The authors declare that they have no conflicts of interest in connection with the manuscript.

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Lützen, U., Zuhayra, M., Marx, M. et al. Value and efficiency of sentinel lymph node diagnostics in patients with penile carcinoma with palpable inguinal lymph nodes as a new multimodal, minimally invasive approach. Eur J Nucl Med Mol Imaging 43, 2313–2323 (2016). https://doi.org/10.1007/s00259-016-3482-6

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