Abstract
Purpose
The purpose of this study was to analyse the incidence and cause of non-visualization of sentinel lymph nodes on preoperative lymphoscintigrams for penile cancer and its implications for further management.
Methods
Preoperative lymphoscintigraphy was performed after injection of 99mTc-labelled nanocolloid in 123 clinically node-negative penile carcinoma patients. Anterior dynamic lymphoscintigraphy was performed during 20 min immediately after tracer injection. Subsequently, 5-min anterior and lateral static images were obtained 30 min and 2 h post injection.
Results
Lymphatic drainage to both groins was seen in 98 patients (79%), unilateral drainage in 23 patients (19%) and no drainage at all in two patients (2%). Thus, in 27 (11%) of 246 groins, no sentinel node was visualized. The amount of administered tracer dose was associated with non-visualization (p=0.01). Unilateral drainage was initially interpreted as a normal physiological phenomenon. After the occurrence of a tumour-positive node in a non-visualized groin, we explore non-visualized groins by blue dye mapping and intraoperative palpation. Sentinel nodes were retrieved in four out of eight such groins, of which one contained metastasis.
Conclusion
In penile carcinoma patients, preoperative lymphoscintigraphy visualizes a sentinel node in 89% of groins. Visualization depends on the administered tracer dose. It is worthwhile to explore non-visualized groins. Sentinel nodes can be intraoperatively identified in more than half of these cases.
References
Cabañas RM. Anatomy and biopsy of sentinel lymph nodes. Urol Clin North Am 1992;19:267–76.
Soria JC, Fizazi K, Piron D, Kramar A, Gerbaulet A, Haie-Meder C, et al. Squamous cell carcinoma of the penis: multivariate analysis of prognostic factors and natural history in monocentric study with a conservative policy. Ann Oncol 1997;8:1089–98.
Solsona E, Algaba F, Horenblas S, Pizzocaro G, Windahl T, European Association of Urology. EAU guidelines on penile cancer. Eur Urol 2004;46:1–8.
Abi-Aad AS, deKernion JB. Controversies in ilioinguinal lymphadenectomy for cancer of the penis. Urol Clin North Am 1992;19:319–24.
Bevan-Thomas R, Slaton JW, Pettaway CA. Contemporary morbidity from lymphadenectomy for penile squamous cell carcinoma: the M.D. Anderson Cancer Center Experience. J Urol 2002;167:1638–42.
Horenblas S, Jansen L, Meinhardt W, Hoefnagel CA, de Jong D, Nieweg OE. Detection of occult metastasis in squamous cell carcinoma of the penis using a dynamic sentinel node procedure. J Urol 2000;163:100–4.
Tanis PJ, Lont AP, Meinhardt W, Olmos RA, Nieweg OE, Horenblas S. Dynamic sentinel node biopsy for penile cancer: reliability of a staging technique. J Urol 2002;168:76–80.
Kroon BK, Horenblas S, Deurloo EE, Nieweg OE, Teertstra HJ. Ultrasonography-guided fine-needle aspiration cytology before sentinel node biopsy in patients with penile carcinoma. BJU Int 2005;95:517–21.
Tanis PJ, van Sandick JW, Nieweg OE, Valdes Olmos RA, Rutgers EJ, Hoefnagel CA, et al. The hidden sentinel node in breast cancer. Eur J Nucl Med Mol Imaging 2002;29:305–11.
Brenot-Rossi I, Houvenaeghel G, Jacquemier J, Bardou VJ, Martino M, Hassan-Sebbag N, et al. Nonvisualization of axillary sentinel node during lymphoscintigraphy: is there a pathologic significance in breast cancer? J Nucl Med 2003;44:1232–7.
Krausz Y, Ikeda DM, Jadvar H, Langleben D, Birdwell R, Strauss HW. Non-visualization of sentinel lymph node in patients with breast cancer. Nucl Med Commun 2001;22:25–32.
Birdwell RL, Smith KL, Betts BJ, Ikeda DM, Strauss HW, Jeffrey SS. Breast cancer: variables affecting sentinel lymph node visualization at preoperative lymphoscintigraphy. Radiology 2001;220:47–53.
Moffat FL Jr, Gulec SA, Sittler SY, Serafini AN, Sfakianakis GN, Boggs JE, et al. Unfiltered sulfur colloid and sentinel node biopsy for breast cancer: technical and kinetic considerations. Ann Surg Oncol 1999;6:746–55.
Morton DL, Wen DR, Wong JH, Economou JS, Cagle LA, Storm FK, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg 1992;127:392–9.
Kroon BK, Horenblas S, Meinhardt W, van der Poel HG, Bex A, van Tinteren H, et al. Dynamic sentinel node biopsy in penile carcinoma: evaluation of 10 years experience. Eur Urol 2005;47:601–6.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kroon, B.K., Valdés Olmos, R., Nieweg, O.E. et al. Non-visualization of sentinel lymph nodes in penile carcinoma. Eur J Nucl Med Mol Imaging 32, 1096–1099 (2005). https://doi.org/10.1007/s00259-005-1822-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00259-005-1822-z