Preoperative Lymphoscintigraphy And Dynamic Sentinel Node Biopsy For Staging Penile Cancer: Results With Pathological Correlation

Main Category: Urology / Nephrology
Also Included In: Cancer / Oncology;  Men's health
Article Date: 03 Jun 2007 - 0:00 PDT

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UroToday.com- An inguinal lymph node dissection (ILND) for penile carcinoma is associated with surgical morbidity. A long-standing issue in the staging of this disease is whether a dynamic sentinel lymph node biopsy (DSNB) is adequate to avoid the ILND. Dr. Spiess and associates at MD Anderson Cancer Center and collaborating institutions reported on this topic in the June 2007 issue of the Journal of Urology.

The goal of lymphatic mapping is to determine if penile carcinoma has spread to the inguinal lymph nodes without performing an ILND. The researchers determined the sensitivity of preoperative 99mTc labeled sulfur-colloid preoperative lymphoscintigraphy (POL) and DSNB with 99mTc labeled sulfur-colloid plus blue dye or with blue dye alone for identifying sentinel lymph node involvement of penile cancer.

A total of 31 men with invasive penile carcinoma and nonpalpable (29 patients) or nonsuspicious (2 patients) inguinal lymph nodes were studied. POL with 99mTc labeled sulfur-colloid and blue dye followed by DSNB was performed in 21 patients and blue dye alone was used in 10 men. The tracers were injected at the edge of the tumor lesion and the DSNB considered positive if the blue dye traced directly to a lymph node group or when the gamma counts obtained using a hand-held probe were at least 5-fold higher than background. All patients underwent ILND at the time of DSNB. If the superficial lymph nodes were positive, the ipsilateral deep inguinal and pelvic lymph nodes were surgically removed. Patients underwent routine postoperative surveillance.

In the follow-up, 28 patients were alive and 1 had died of penile cancer and 2 of other causes, median follow-up were 3.0 years. Of the 21 men who had POL, 12 (57%) had bilateral positive, 8 (38%) had unilateral positive and 1 (5%) had bilateral negative scintigraphy. 5 of 8 patients (63%) with a unilateral positive POL had a sentinel node unexpectedly detected on the contralateral side by DSNB at surgery but none of these lymph nodes had metastases on pathological evaluation. Six of 32 inguinal regions that demonstrated drainage on preoperative lymphoscintigraphy had inguinal node metastasis, as did 1 of 10 that was drainage negative. This resulted in a preoperative lymphoscintigraphy sensitivity of 86%. The combination of blue dye and POL yielded 5 positive for cancer by DSNB but 2 false-negative results were obtained. The sensitivity of DSNB per groin for penile carcinoma detection was 71%. The authors conclude that this result suggests that the technology is not yet sufficient to replace the superficial lymph node dissection.

Spiess PE, Izawa JI, Bassett R, Kedar D, Busby JE, Wong F, Eddings T, Tamboli P, Pettaway CA

J Urol. 177(6); 2157-2161, June 2007
doi:10.1016/j.juro.2007.01.125

Reported by UroToday.com Contributing Editor Christopher P. Evans, M.D.

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