DYNAMIC SENTINEL NODE BIOPSY (DSNB) IN PATIENTS WITH CLINICAL POSITIVE INGUINAL NODE METASTASIS FROM PENILE CANCER.

Mario Achille Catanzaro1, Alice Lorenzoni1, Nicola Nicolai1, Marco Maccauro1, Tullio Torelli1, Gianluca Aliberti1, Luigi Piva1, Massimo Maffezzini1, Silvia Stagni1, Davide Biasoni1, Mattia Calandriello1, Andrea Necchi1, Patrizia Giannatempo1, Elena Farè1, Daniele Raggi1, Manuela Marongiu1, Flavio Crippa1, Roberto Salvioni1
  • 1 Fondazione IRCCS Istituto Nazionale dei Tumori (Milano)

Objective

Early detection of inguinal nodal metastasis from penile cancer is mandatory. Inguinal lymphadenectomy (ILND) is advised in patients with invasive or high grade cancer as stated by EAU guide lines (1), nevertheless it has major morbidity. In high volume centers dynamic sentinel node biopsy (DSNB) is performed to decrease negative lymph node dissection to reduce the morbidity (2-3). This study analyzed data about patients with clinical positive inguinal nodes (cN+), who underwent lymphadenectomy on the cN+ side. DSNB was performed on the opposite clinical negative side as stated by physical, ultrasound (US) and eventually fine-needle agobiopsy (FNAB). The aim of the study is to assess the false negative rate, negative predictive value (NPV) and sensitivity, as well as complications of DSNB procedure.

Methods and results

From 01-2000 to 12-2013, 110 patients underwent DSNB: we retrieved from our prospectively database on penile SCC kept about 14 patients (pts) (mean age 54 years, range 38-65) with penile squamous cell carcinoma pT1-3 and cN+ inguinal staging. Patient with palpable inguinal nodes were studied with ultrasound (US) and fine-needle agobiopsy (FNAB) if required. If US and/or FNAB were negative we performed DSNB, if positive ILND. The sentinel node was detected by gamma camera study and blue eye detection after lymphoscintigraphy performed the same day of the surgery and blue dye had been injected intradermally around penile tumor or in the penile shaft just before surgery. A contralateral ILND on the metastatic side was performed at the same time of monolateral DSNB (mDSNB) on the cN0 groin. The positive mDSNB patients underwent ILND. After surgery we recorded major complications and all patients started a follow up schedule.
14 pts (7 pts with pT1, 4 pts with pT2 and 3 pts with pT3) cN+ on one groin underwent a concomitant mDSNB on the cN0 groin and a contralateral ILND on the cN+ groin. The pathological nodal status on the ILND groin were: 4 pN0, 3 pN1, 4 pN2 and 3 pN3. On the mDSNB we found 12 negative sentinel node and 2 positive nodes. The 2 pts with positive DSNB underwent ILND: 1 pt had pN1, 1 pt pN2. One pt with negative mDSNB (1/12) relapsed at 25 months follow-up (pN2), 11/12 (91.7%) are negative at median follow-up of 58 months (range 23-114). Overall, we recorded 3/14 affected groin (21.4%). The false negative rate (FNR) was 8.3% (1/12) leading to a relatively good NPV of 78.6% (11/14), but to a fair sensitivity of 66% (2/3). We did not find major complications. We observed in two pts judged cN+ on one side, who underwent ILND, a pN0 pathological status, and one of these, on the cN0 groin, had a positive mDSNB.

Discussion

14 pts (7 pts with pT1, 4 pts with pT2 and 3 pts with pT3) cN+ on one groin underwent a concomitant mDSNB on the cN0 groin and a contralateral ILND on the cN+ groin. The pathological nodal status on the ILND groin were: 4 pN0, 3 pN1, 4 pN2 and 3 pN3. On the mDSNB we found 12 negative sentinel node and 2 positive nodes. The 2 pts with positive DSNB underwent ILND: 1 pt had pN1, 1 pt pN2. One pt with negative mDSNB (1/12) relapsed at 25 months follow-up (pN2), 11/12 (91.7%) are negative at median follow-up of 58 months (range 23-114). Overall, we recorded 3/14 affected groin (21.4%). The false negative rate (FNR) was 8.3% (1/12) leading to a relatively good NPV of 78.6% (11/14), but to a fair sensitivity of 66% (2/3). We did not find major complications. We observed in two pts judged cN+ on one side, who underwent ILND, a pN0 pathological status, and one of these, on the cN0 groin, had a positive mDSNB.

References

1. Pizzocaro G, Algaba F, Horenblas S, Solsona E, Tana S, Van Der Poel H, Watkin NA; European Association of Urology (EAU) Guidelines Group on Penile Cancer. EAU penile cancer guidelines 2009. Eur Urol. 2010 Jun;57(6):1002-12
2. Graafland NM, Valdés Olmos RA, Meinhardt W, Bex A, van der Poel HG, van Boven HH, Nieweg OE, Horenblas S. Nodal staging in penile carcinoma by dynamic sentinel node biopsy after previous therapeutic primary tumour resection. Eur Urol. 2010 Nov;58(5):748-51.
3. Lam W, Alnajjar HM, La-Touche S, Perry M, Sharma D, Corbishley C, Pilcher J, Heenan S, Watkin N. Dynamic sentinel lymph node biopsy in patients with invasive squamous cell carcinoma of the penis: a prospective study of the long-term outcome of 500 inguinal basins assessed at a single institution. Eur Urol. 2013 Apr;63(4):657-63.

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