Skip to main content
SpringerLink
Log in

Fluorescence diagnosis: a novel method to guide radical inguinal lymph node dissection in penile cancer

  • Free Paper
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

In penile cancer there is still a diagnostic dilemma between over treatment of lymph node-negative patients and the missing of occult metastases by watchful waiting. In the current study the value of fluorescence diagnosis during radical inguinal lymph node dissection was evaluated. Five patients with penile cancer were elected to undergo groin dissection. All patients received 5-aminolevulinic acid (5-ALA) orally before the operation for fluorescence diagnosis. Intraoperatively, fluorescence detection of the lymph nodes was performed by visual detection and spectroscopy. Two of the five patients had positive inguinal lymph nodes. Fluorescence in tumor-bearing tissue was detectable in the exposed lymph nodes. Protoporphyrin IX (PPIX) is accumulated in tumor-positive lymph nodes, making fluorescence diagnosis in penile cancer possible. More studies with higher patient numbers are necessary to evaluate optimal dosage and excitation conditions to detect tumor-bearing nodes in vivo.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Brkovic D, Kalble T, Dorsam J, Pomer S, Lotzerich C, Banafsche R, Riedasch G, Staehler G (1997) Surgical treatment of invasive penile cancer—the Heidelberg experience from 1968 to 1994. Eur Urol 31:339–342

    CAS  PubMed  Google Scholar 

  2. Cabanas RM (1977) An approach for the treatment of penile carcinoma. Cancer 39:456–459

    PubMed  Google Scholar 

  3. Canis M, Botchorishvili R, Berreni N, Manhes H, Wattiez A, Mage G, Pouly JL, Bruhat MA (2001) 5-aminolevulinic acid-induced (ALA) fluorescence for the laparoscopic diagnosis of peritoneal metastasis. Surg Endosc 15:1184–1186

    CAS  PubMed  Google Scholar 

  4. Catalona WJ (1988) Modified inguinal lymphadenectomy for carcinoma of the penis with preservation of saphenous veins: technique and preliminary results. J Urol 140:306–310

    CAS  PubMed  Google Scholar 

  5. Cloberg JW, Andriole GL, Catalona WJ (1997) Long-term follow-up of men undergoing modified inguinal lymphadenectomy for carcinoma of the penis. Br J Urol 79:54–57

    PubMed  Google Scholar 

  6. Daeseler EH, Anson BH, Reimann AF (1948) Radical excision of the inguinal and iliac lymph glands: a study based upon 450 anatomical dissections and upon supportive clinical observations. Surg Gynecol Obstet 87:779

    Google Scholar 

  7. Frimberger D, Zaak D and Hofstetter A (2000) Endoscopic fluorescence diagnosis and laser treatment of transitional cell carcinoma of the bladder. Semin Urol Oncol 18:264–272

    CAS  PubMed  Google Scholar 

  8. Horenblas S, vanTinteren H, Delemarre JF, Moonen LM, Lustig V, Kroger R (1991) Squamous cell carcinoma of the penis: accuracy of tumor, nodes and metastasis classification system, and role of lymphangiography, computerized tomography scan and fine needle aspiration cytology. J Urol 146:1279–1283

    CAS  PubMed  Google Scholar 

  9. Horenblas S, van Tinteren H, Delemarre JF, Moonen LM, Lustig V, van Waardenburg EW (1993) Squamous cell carcinoma of the penis. III. Treatment of the regional lymph nodes. J Urol 149:492–497

    CAS  PubMed  Google Scholar 

  10. Horenblas S, Jansen L, Meinhard W, Hoefnagel CA, de Jong D, Nieweg OE, Theodorescu D (2000) Detection of occult metastasis in squamous cell carcinoma of the penis using a dynamic sentinel node procedure. J Urol 163:100–104

    CAS  PubMed  Google Scholar 

  11. Hussein A, Benefetto P, Sridhar KS (1990) Chemotherapy with cisplatin and 5-fluouracil for penile and urethral squamous cancers. Cancer 65:433–438

    CAS  PubMed  Google Scholar 

  12. McDougal WS (1995) Carcinoma of the penis: improved survival by early regional lymphadenectomy based on histologic grade and depth of invasion of the primary lesion. J Urol 154:1364–1366

    CAS  PubMed  Google Scholar 

  13. Mobilio G, Ficarra V (2001) Genital treatment of penile carcinoma. Curr Opin Urol 11:299–204

    CAS  PubMed  Google Scholar 

  14. Ornellas AA, Seixas AL, Marota A, Wisnescky A, Campos F de Moraes JR (1994) Surgical treatment of invasive squamous cell carcinoma of the penis: retrospective analysis of 350 cases. J Urol 151:1244–1249

    CAS  PubMed  Google Scholar 

  15. Perinetti EP, Crane DB, Catalona WJ (1980) Unreliability of sentinel lymph node biopsy for staging penile carcinoma. J Urol 124:734

    CAS  PubMed  Google Scholar 

  16. Persky L, De Kernion J (1986) Carcinoma of the penis. CA Cancer J Clin 36:258–273

    CAS  PubMed  Google Scholar 

  17. Pizzocaro G, Piva L, Bandieramonte G, Tana S (1997) Up-to-date management of the carcinoma of the penis. Eur Urol 32:5–15

    CAS  PubMed  Google Scholar 

  18. Schneede P, Frimberger D, Zaak D, Hofstetter A (2001) Fluorescence diagnosis of penile carcinomas—a new technique to assist and control Nd:YAG laser therapy. Med Laser Appl 16:43–48

    Google Scholar 

  19. Steinbach P, Kriegmair M, Baumgartner R, Hofstaedter F, Knuechel R (1994) Intravesical instillation of 5-aminolevulinic acid: the fluorescent metabolite is limited to urothelial cells. Urology 44:676–681

    CAS  PubMed  Google Scholar 

  20. Wawroschek F, Vogt H, Bachter D, Weckermann D, Hamm M, Harzmann R (2000) First experience with gamma probe guided sentinel lymph node surgery in penile cancer. Urol Res 28:246–249

    Article  CAS  PubMed  Google Scholar 

  21. Wespes E, Simon J, Schulman CC (1986) Cabanas approach: is sentinel lymph node biopsy reliable for staging penile carcinoma? Urology 28:278–279

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, Klinikum Großhadern, Ludwig Maximilians University, Munich, Germany

    D. Frimberger, D. Zaak, E. Hungerhuber, R. Waidelich, A. Hofstetter & P. Schneede

  2. Johns Hopkins Hospital, 600 N. Wolfe Street, Park Building B2–202, Baltimore, MD 21287–1255, USA

    D. Frimberger

  3. Department of Nuclear Medicine, Klinikum Großhadern, Ludwig Maximilians University, Munich, Germany

    R. Linke

  4. Department of Pathology, Klinikum Großhadern, Ludwig Maximilians University, Munich, Germany

    H. Meissner

  5. Laser Research Laboratory, Klinikum Großhadern, Ludwig Maximilians University, Munich, Germany

    H. Stepp

  6. Department of Urology, St. Johannsspital, Salzburg, Austria

    N. Schmeller

Authors
  1. D. Frimberger
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Linke
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. H. Meissner
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. H. Stepp
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. D. Zaak
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. E. Hungerhuber
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. R. Waidelich
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. N. Schmeller
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. A. Hofstetter
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. P. Schneede
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to D. Frimberger.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Frimberger, D., Linke, R., Meissner, H. et al. Fluorescence diagnosis: a novel method to guide radical inguinal lymph node dissection in penile cancer. World J Urol 22, 150–154 (2004). https://doi.org/10.1007/s00345-003-0352-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-003-0352-1

Keywords

Search

Navigation