Management of Lymph Nodes

  • Niels M. Graafland
  • Simon Horenblas
Chapter
First Online:

Abstract

The majority of penile cancers are squamous cell carcinomas (∼95%) which typically show a step-wise lymphogenic spread prior to hematogenic dissemination. The primary draining lymph nodes are invariably located within the inguinal lymphatic region. Thereafter, dissemination usually continues to the pelvic nodes and/or distant sites. At initial presentation, distant metastases are present in only 1–2% of the patients and are virtually always associated with clinically evident lymph node metastases.

Keywords

Sentinel Node Fine Needle Aspiration Cytology Inguinal Lymph Node Pelvic Node Dissection Penile Cancer 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in to check access.

References

  1. 1.
    Srinivas V, Morse MJ, Herr HW, Sogani PC, Whitmore WF Jr. Penile cancer: relation of extent of nodal metastasis to survival. J Urol. 1987;137:880.PubMedGoogle Scholar
  2. 2.
    Ravi R. Correlation between the extent of nodal involvement and survival following groin dissection for carcinoma of the penis. Br J Urol. 1993;72:817.PubMedCrossRefGoogle Scholar
  3. 3.
    Horenblas S, van Tinteren H. Squamous cell carcinoma of the penis. IV. Prognostic factors of survival: analysis of tumor, nodes and metastasis classification system. J Urol. 1994;151:1239.PubMedGoogle Scholar
  4. 4.
    Lont AP, Kroon BK, Gallee MP, van Tinteren H, Moonen LM, Horenblas S. Pelvic lymph node dissection for penile carcinoma: extent of inguinal lymph node involvement as an indicator for pelvic lymph node involvement and survival. J Urol. 2007;177:947.PubMedCrossRefGoogle Scholar
  5. 5.
    Sanchez-Ortiz RF, Pettaway CA. The role of lymphadenectomy in penile cancer. Urol Oncol. 2004;22:236.PubMedCrossRefGoogle Scholar
  6. 6.
    Pandey D, Mahajan V, Kannan RR. Prognostic factors in node-positive carcinoma of the penis. J Surg Oncol. 2006;93:133.PubMedCrossRefGoogle Scholar
  7. 7.
    Ornellas AA, Kinchin EW, Nobrega BL, Wisnescky A, Koifman N, Quirino R. Surgical treatment of invasive squamous cell carcinoma of the penis: Brazilian National Cancer Institute long-term experience. J Surg Oncol. 2008;97:487.PubMedCrossRefGoogle Scholar
  8. 8.
    Wespes E. The management of regional lymph nodes in patients with penile carcinoma and reliability of sentinel node biopsy. Eur Urol. 2007;52:15.PubMedCrossRefGoogle Scholar
  9. 9.
    Solsona E, Algaba F, Horenblas S, Pizzocaro G, Windahl T. EAU guidelines on penile cancer. Eur Urol. 2004;46:1.PubMedCrossRefGoogle Scholar
  10. 10.
    Hegarty PK, Kayes O, Freeman A, Christopher N, Ralph DJ, Minhas S. A prospective study of 100 cases of penile cancer managed according to European Association of Urology guidelines. BJU Int. 2006;98:526.PubMedCrossRefGoogle Scholar
  11. 11.
    Johnson DE, Lo RK. Complications of groin dissection in penile cancer. Experience with 101 lymphadenectomies. Urology. 1984;24:312.PubMedCrossRefGoogle Scholar
  12. 12.
    Ravi R. Morbidity following groin dissection for penile carcinoma. Br J Urol. 1993;72:941.PubMedCrossRefGoogle Scholar
  13. 13.
    Ornellas AA, Seixas AL, de Moraes JR. Analyses of 200 lymphadenectomies in patients with penile carcinoma. J Urol. 1991;146:330.PubMedGoogle Scholar
  14. 14.
    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.PubMedCrossRefGoogle Scholar
  15. 15.
    Hadway P, Smith Y, Corbishley C, Heenan S, Watkin NA. Evaluation of dynamic lymphoscintigraphy and sentinel lymph-node biopsy for detecting occult metastases in patients with penile squamous cell carcinoma. BJU Int. 2007;100:561.PubMedCrossRefGoogle Scholar
  16. 16.
    Kroon BK, Valdés Olmos R, Nieweg OE, Horenblas S. Non-visualization of sentinel lymph nodes in penile carcinoma. Eur J Nucl Med Mol Imaging. 2005;32:1096.PubMedCrossRefGoogle Scholar
  17. 17.
    Daseler EH, Anson BJ, Reimann AF. Radical excision of the inguinal and iliac lymph glands; a study based upon 450 anatomical dissections and upon supportive clinical observations. Surg Gynecol Obstet. 1948;87:679.PubMedGoogle Scholar
  18. 18.
    Dewire D, Lepor H. Anatomic considerations of the penis and its lymphatic drainage. Urol Clin North Am. 1992;19:211.PubMedGoogle Scholar
  19. 19.
    Leijte JA, Valdes Olmos RA, Nieweg OE, Horenblas S. Anatomical mapping of lymphatic drainage in penile carcinoma with SPECT-CT: implications for the extent of inguinal lymph node dissection. Eur Urol. 2008;54:885.PubMedCrossRefGoogle Scholar
  20. 20.
    Cabanas RM. Anatomy and biopsy of sentinel lymph nodes. Urol Clin North Am. 1992;19:267.PubMedGoogle Scholar
  21. 21.
    Lont AP, Gallee MP, Snijders P, Horenblas S. Sarcomatoid squamous cell carcinoma of the penis: a clinical and pathological study of 5 cases. J Urol. 2004;172:932.PubMedCrossRefGoogle Scholar
  22. 22.
    Zhu Y, Zhang SL, Ye DW, et al. Prospectively packaged ilioinguinal lymphadenectomy for penile cancer: the disseminative pattern of lymph node metastasis. J Urol. 2009;181:2103.PubMedCrossRefGoogle Scholar
  23. 23.
    Kroon BK, Valdes Olmos RA, van der Poel HG, Nieweg OE, Horenblas S. Prepubic sentinel node location in penile carcinoma. Clin Nucl Med. 2005;30:649.PubMedCrossRefGoogle Scholar
  24. 24.
    McDougal WS. Carcinoma of the penis: improved survival by early regional lymphadenectomy based on the histological grade and depth of invasion of the primary lesion. J Urol. 1995;154:1364.PubMedCrossRefGoogle Scholar
  25. 25.
    Lont AP, Horenblas S, Tanis PJ, Gallee MP, van Tinteren H, Nieweg OE. Management of clinically node negative penile carcinoma: improved survival after the introduction of dynamic sentinel node biopsy. J Urol. 2003;170:783.PubMedCrossRefGoogle Scholar
  26. 26.
    Kroon BK, Horenblas S, Lont AP, Tanis PJ, Gallee MP, Nieweg OE. Patients with penile carcinoma benefit from immediate resection of clinically occult lymph node metastases. J Urol. 2005;173:816.PubMedCrossRefGoogle Scholar
  27. 27.
    Persson B, Sjodin JG, Holmberg L, Windahl T. The National Penile Cancer Register in Sweden 2000-2003. Scand J Urol Nephrol. 2007;41:278.PubMedCrossRefGoogle Scholar
  28. 28.
    Ornellas AA, Seixas AL, Marota A, Wisnescky A, Campos F, de Moraes JR. Surgical ­treatment of invasive squamous cell carcinoma of the penis: retrospective analysis of 350 cases. J Urol. 1994;151:1244.PubMedGoogle Scholar
  29. 29.
    Horenblas S, van Tinteren H, Delemarre JF, Moonen LM, Lustig V, Kroger R. 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. 1991;146:1279.PubMedGoogle Scholar
  30. 30.
    Pizzocaro G, Algaba F, Horenblas S, et al. EAU penile cancer guidelines 2009. Eur Urol. 2010;57:1002.PubMedCrossRefGoogle Scholar
  31. 31.
    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.PubMedCrossRefGoogle Scholar
  32. 32.
    Saisorn I, Lawrentschuk N, Leewansangtong S, Bolton DM. Fine-needle aspiration cytology predicts inguinal lymph node metastasis without antibiotic pretreatment in penile carcinoma. BJU Int. 2006;97:1225.PubMedCrossRefGoogle Scholar
  33. 33.
    Jensen JB, Jensen KM, Ulhoi BP, Nielsen SS, Lundbeck F. Sentinel lymph-node biopsy in patients with squamous cell carcinoma of the penis. BJU Int. 2009;103:1199.PubMedCrossRefGoogle Scholar
  34. 34.
    Tabatabaei S, Harisinghani M, McDougal WS. Regional lymph node staging using lymphotropic nanoparticle enhanced magnetic resonance imaging with ferumoxtran-10 in patients with penile cancer. J Urol. 2005;174:923.PubMedCrossRefGoogle Scholar
  35. 35.
    Thoeny HC, Triantafyllou M, Birkhaeuser FD, et al. Combined ultrasmall superparamagnetic particles of iron oxide-enhanced and diffusion-weighted magnetic resonance imaging reliably detect pelvic lymph node metastases in normal-sized nodes of bladder and prostate cancer patients. Eur Urol. 2009;55:761.PubMedCrossRefGoogle Scholar
  36. 36.
    Lardinois D, Weder W, Hany TF, et al. Staging of non-small-cell lung cancer with integrated positron-emission tomography and computed tomography. N Engl J Med. 2003;348:2500.PubMedCrossRefGoogle Scholar
  37. 37.
    Antoch G, Saoudi N, Kuehl H, et al. Accuracy of whole-body dual-modality fluorine-18-2-fluoro-2-deoxy-D-glucose positron emission tomography and computed tomography (FDG-PET/CT) for tumor staging in solid tumors: comparison with CT and PET. J Clin Oncol. 2004;22:4357.PubMedCrossRefGoogle Scholar
  38. 38.
    Ng SH, Yen TC, Chang JT, et al. Prospective study of [18F]fluorodeoxyglucose positron emission tomography and computed tomography and magnetic resonance imaging in oral cavity squamous cell carcinoma with palpably negative neck. J Clin Oncol. 2006;24:4371.PubMedCrossRefGoogle Scholar
  39. 39.
    Scher B, Seitz M, Reiser M, et al. 18F-FDG PET/CT for staging of penile cancer. J Nucl Med. 2005;46:1460.PubMedGoogle Scholar
  40. 40.
    Leijte JA, Graafland NM, Valdes Olmos RA, van Boven HH, Hoefnagel CA, Horenblas S. Prospective evaluation of hybrid (18)F-fluorodeoxyglucose positron emission tomography/computed tomography in staging clinically node-negative patients with penile carcinoma. BJU Int. 2009;104:640.PubMedCrossRefGoogle Scholar
  41. 41.
    Zhu Y, Zhang SL, Ye DW, Yao XD, Jiang ZX, Zhou XY. Predicting pelvic lymph node metastases in penile cancer patients: a comparison of computed tomography, Cloquet’s node, and disease burden of inguinal lymph nodes. Onkologie. 2008;31:37.PubMedCrossRefGoogle Scholar
  42. 42.
    Graafland NM, Leijte JA, Valdes Olmos RA, Hoefnagel CA, Teertstra HJ, Horenblas S. Scanning with 18F-FDG-PET/CT for detection of pelvic nodal involvement in inguinal node-positive penile carcinoma. Eur Urol. 2009;56:339.PubMedCrossRefGoogle Scholar
  43. 43.
    Solsona E, Iborra I, Rubio J, Casanova JL, Ricos JV, Calabuig C. Prospective validation of the association of local tumor stage and grade as a predictive factor for occult lymph node ­micrometastasis in patients with penile carcinoma and clinically negative inguinal lymph nodes. J Urol. 2001;165:1506.PubMedCrossRefGoogle Scholar
  44. 44.
    Naumann CM, Alkatout I, Al Najar A, et al. Lymph-node metastases in intermediate-risk squamous cell carcinoma of the penis. BJU Int. 2008;102:1102.PubMedCrossRefGoogle Scholar
  45. 45.
    Theodorescu D, Russo P, Zhang ZF, Morash C, Fair WR. Outcomes of initial surveillance of invasive squamous cell carcinoma of the penis and negative nodes. J Urol. 1996;155:1626.PubMedCrossRefGoogle Scholar
  46. 46.
    Ficarra V, Zattoni F, Artibani W, et al. Nomogram predictive of pathological inguinal lymph node involvement in patients with squamous cell carcinoma of the penis. J Urol. 2006;175:1700.PubMedCrossRefGoogle Scholar
  47. 47.
    Slaton JW, Morgenstern N, Levy DA, et al. Tumor stage, vascular invasion and the percentage of poorly differentiated cancer: independent prognosticators for inguinal lymph node metastasis in penile squamous cancer. J Urol. 2001;165:1138.PubMedCrossRefGoogle Scholar
  48. 48.
    Ornellas AA, Nobrega BL, Wei Kin Chin E, Wisnescky A, da Silva PC, Santos Schwindt AB. Prognostic factors in invasive squamous cell carcinoma of the penis: analysis of 196 patients treated at the Brazilian National Cancer Institute. J Urol. 2008;180:1354.PubMedCrossRefGoogle Scholar
  49. 49.
    Velazquez EF, Ayala G, Liu H, et al. Histologic grade and perineural invasion are more important than tumor thickness as predictor of nodal metastasis in penile squamous cell carcinoma invading 5 to 10 mm. Am J Surg Pathol. 2008;32:974.PubMedCrossRefGoogle Scholar
  50. 50.
    Lopes A, Hidalgo GS, Kowalski LP, Torloni H, Rossi BM, Fonseca FP. Prognostic factors in carcinoma of the penis: multivariate analysis of 145 patients treated with amputation and lymphadenectomy. J Urol. 1996;156:1637.PubMedCrossRefGoogle Scholar
  51. 51.
    Ficarra V, Zattoni F, Cunico SC, et al. Lymphatic and vascular embolizations are independent predictive variables of inguinal lymph node involvement in patients with squamous cell carcinoma of the penis: Gruppo Uro-Oncologico del Nord Est (Northeast Uro-Oncological Group) Penile Cancer data base data. Cancer. 2005;103:2507.PubMedCrossRefGoogle Scholar
  52. 52.
    Leijte JA, Kroon BK, Valdés Olmos RA, Nieweg OE, Horenblas S. Reliability and safety of current dynamic sentinel node biopsy for penile carcinoma. Eur Urol. 2007;52:170.PubMedCrossRefGoogle Scholar
  53. 53.
    Catalona WJ. Modified inguinal lymphadenectomy for carcinoma of the penis with preservation of saphenous veins: technique and preliminary results. J Urol. 1988;140:306.PubMedGoogle Scholar
  54. 54.
    Parra RO. Accurate staging of carcinoma of the penis in men with nonpalpable inguinal lymph nodes by modified inguinal lymphadenectomy. J Urol. 1996;155:560.PubMedCrossRefGoogle Scholar
  55. 55.
    Lopes A, Rossi BM, Fonseca FP, Morini S. Unreliability of modified inguinal lymphadenectomy for clinical staging of penile carcinoma. Cancer. 1996;77:2099.PubMedCrossRefGoogle Scholar
  56. 56.
    D’Ancona CA, de Lucena RG, Querne FA, Martins MH, Denardi F, Netto NR Jr. Long-term followup of penile carcinoma treated with penectomy and bilateral modified inguinal lymphadenectomy. J Urol. 2004;172:498.PubMedCrossRefGoogle Scholar
  57. 57.
    Colberg JW, Andriole GL, Catalona WJ. Long-term follow-up of men undergoing modified inguinal lymphadenectomy for carcinoma of the penis. Br J Urol. 1997;79:54.PubMedGoogle Scholar
  58. 58.
    Cabanas RM. An approach for the treatment of penile carcinoma. Cancer. 1977;39:456.PubMedCrossRefGoogle Scholar
  59. 59.
    Morton DL, Wen DR, Wong JH, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg. 1992;127:392.PubMedGoogle Scholar
  60. 60.
    Leijte JA, Hughes B, Graafland NM, et al. Two-center evaluation of dynamic sentinel node biopsy for squamous cell carcinoma of the penis. J Clin Oncol. 2009;27:3325.PubMedCrossRefGoogle Scholar
  61. 61.
    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.PubMedCrossRefGoogle Scholar
  62. 62.
    Kroon BK, Horenblas S, Estourgie SH, Lont AP, Valdes Olmos RA, Nieweg OE. How to avoid false-negative dynamic sentinel node procedures in penile carcinoma. J Urol. 2004;171:2191.PubMedCrossRefGoogle Scholar
  63. 63.
    Kroon BK, Lont AP, Valdés Olmos RA, Nieweg OE, Horenblas S. Morbidity of dynamic sentinel node biopsy in penile carcinoma. J Urol. 2005;173:813.PubMedCrossRefGoogle Scholar
  64. 64.
    Leijte JA, Kerst JM, Bais E, Antonini N, Horenblas S. Neoadjuvant chemotherapy in advanced penile carcinoma. Eur Urol. 2007;52:488.PubMedCrossRefGoogle Scholar
  65. 65.
    Horenblas S, van Tinteren H, Delemarre JF, Moonen LM, Lustig V, van Waardenburg EW. Squamous cell carcinoma of the penis. III. Treatment of regional lymph nodes. J Urol. 1993;149:492.PubMedGoogle Scholar
  66. 66.
    Horenblas S. Lymphadenectomy for squamous cell carcinoma of the penis. Part 2: the role and technique of lymph node dissection. BJU Int. 2001;88:473.PubMedCrossRefGoogle Scholar
  67. 67.
    Baronofsky ID. Technique of inguinal node dissection. Surgery. 1948;24:555.PubMedGoogle Scholar
  68. 68.
    Mortenson MM, Xing Y, Weaver S, et al. Fibrin sealant does not decrease seroma output or time to drain removal following inguino-femoral lymph node dissection in melanoma patients: a randomized controlled trial (NCT00506311). World J Surg Oncol. 2008;6:63.PubMedCrossRefGoogle Scholar
  69. 69.
    Carlson JW, Kauderer J, Walker JL, et al. A randomized phase III trial of VH fibrin sealant to reduce lymphedema after inguinal lymph node dissection: a Gynecologic Oncology Group study. Gynecol Oncol. 2008;110:76.PubMedCrossRefGoogle Scholar
  70. 70.
    Melis P, Bos KE, Horenblas S. Primary skin closure of a large groin defect after inguinal lymphadenectomy for penile cancer using a skin stretching device. J Urol. 1998;159:185.PubMedCrossRefGoogle Scholar
  71. 71.
    Kayes OJ, Durrant CA, Ralph D, Floyd D, Withey S, Minhas S. Vertical rectus abdominis flap reconstruction in patients with advanced penile squamous cell carcinoma. BJU Int. 2007;99:37.PubMedCrossRefGoogle Scholar
  72. 72.
    Airhart RA, deKernion JB, Guillermo EO. Tensor fascia lata myocutaneous flap for coverage of skin defect after radical groin dissection for metastatic penile carcinoma. J Urol. 1982;128:599.PubMedGoogle Scholar
  73. 73.
    Tobias-Machado M, Tavares A, Ornellas AA, Molina WR Jr, Juliano RV, Wroclawski ER. Video endoscopic inguinal lymphadenectomy: a new minimally invasive procedure for radical management of inguinal nodes in patients with penile squamous cell carcinoma. J Urol. 2007;177:953.PubMedCrossRefGoogle Scholar
  74. 74.
    Tobias-Machado M, Tavares A, Silva MN, et al. Can video endoscopic inguinal lymphadenectomy achieve a lower morbidity than open lymph node dissection in penile cancer patients? J Endourol. 2008;22:1687.PubMedCrossRefGoogle Scholar
  75. 75.
    Sotelo R, Sanchez-Salas R, Clavijo R. Endoscopic inguinal lymph node dissection for penile carcinoma: the developing of a novel technique. World J Urol. 2009;27:213.PubMedCrossRefGoogle Scholar
  76. 76.
    Bartelink H, Breur K, Hart G, Annyas B, van Slooten E, Snow G. The value of postoperative radiotherapy as an adjuvant to radical neck dissection. Cancer. 1983;52:1008.PubMedCrossRefGoogle Scholar
  77. 77.
    Graafland NM, van Boven HH, Van Werkhoven E, Moonen LM, Horenblas S. Prognostic significance of extranodal extension in pathological node-positive patients with penile carcinoma. J Urol. 2010;184:1347.PubMedCrossRefGoogle Scholar
  78. 78.
    Lopes A, Bezerra AL, Serrano SV, Hidalgo GS. Iliac nodal metastases from carcinoma of the penis treated surgically. BJU Int. 2000;86:690.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Limited 2011

Authors and Affiliations

  • Niels M. Graafland
    • 1
  • Simon Horenblas
    • 2
  1. 1.Department of UrologyThe Netherlands Cancer Institute – Antoni van Leeuwenhoek HospitalAmsterdamThe Netherlands
  2. 2.Department of Urologic OncologyNetherlands Cancer Institute – Antoni van Leeuwenhoek HospitalAmsterdamThe Netherlands

Personalised recommendations