Dynamic sentinel node biopsy in penile cancer. Indications, technique and results in a spanish oncological center.Authors:
Álvaro Gómez-Ferrer, José Rubio, Argimiro Collado, Juan Casanova, José Domínguez, Miguel Ramírez, José Vicente Ricós, José Luis Monrós, Raimundo Dumont, Inmaculada Iborra y Eduardo Solsona.
Arch. Esp. Urol. 2015; 68 (6): 524-531
Vol. 68, Number. 6, Jul/Aug 2015
OBJECTIVE: Penile cancer has a predominantly lymphatic dissemination. Lymph nodes metastatic involvement conditions disease prognosis and inguinal lymph node dissection has both prognostic and therapeutic value. High and intermediate risk patients with non-palpable lymph nodes will benefit of a precise diagnosis by means of selective sentinel node biopsy with minimal surgical aggressiveness.
METHODS: Retrospective review of our experience on dynamic sentinel node biopsy in penile cancer from November 1999 to July 2014.
RESULTS: We performed this procedure in 33 patients, technically successful in 29 (88%). The patients who did not undergo lymph node dissection due to positive sentinel node biopsy have been followed a mean of 60.4 months (Median 59, range 5-145). 20 patients underwent simultaneous sentinel node biopsy and surgical treatment of the primary lesion and in 13 it was performed posteriorly. In these cases the time lapse was 5.5 months (median 5, range 2-12). In 6 (18.9%) of the 29 patients successfully biopsied, metastasis was founded in any of the lymph nodes identified as sentinel. Two patients were false negative (6,25%). Sensitivity (S), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of successfully performed sentinel node biopsies were 66, 100, 100 and 93%, respectively.
CONCLUSION: Sentinel node biopsy enables a correct lymph node staging avoiding the morbidity of inguinal lymph node dissection. The rate of technical failure and false negative results is low and it may be considered the diagnostic technique of choice in high and intermediate risk penile cancer with non-palpable lymph nodes.