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Evaluation of dynamic lymphoscintigraphy and sentinel lymph‐node biopsy for detecting occult metastases in patients with penile squamous cell carcinoma
Author(s) -
Hadway Paul,
Smith Yuko,
Corbishley Cathy,
Heenan Susan,
Watkin Nicholas A.
Publication year - 2007
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2007.07013.x
Subject(s) - medicine , penile cancer , sentinel lymph node , penile carcinoma , lymph , lymph node , radiology , sentinel node , occult , biopsy , groin , micrometastasis , surgery , dissection (medical) , asymptomatic , cancer , penis , metastasis , breast cancer , pathology , alternative medicine
OBJECTIVE To evaluate the introduction of dynamic lymphoscintigraphy and sentinel lymph‐node (SLN) biopsy (used to detect occult lymph node metastases in patients with penile cancer and clinically impalpable inguinal lymph nodes at presentation) at a UK tertiary referral centre for penile cancer. PATIENTS AND METHODS In all, 75 patients with penile squamous cell carcinoma of stage T1, grade ≥ 2, and unilateral or bilateral impalpable groin nodes, were prospectively enrolled over a 2‐year period. Patients underwent lymphoscintigraphy with 99m technetium‐labelled nanocolloid which was injected intradermally around the tumour or into the distal penile shaft skin. Four hours later, the SLN(s) were identified during surgery using a hand‐held γ‐probe and intradermal injections with blue dye. Completion lymph node dissection was subsequently used in patients with tumour‐positive SLNs. RESULTS In all, 255 SLNs were removed from 143 groins; all excised nodes had taken up the radioactive marker, and the blue dye was evident in 87%. Eighteen of 75 (24%) patients and 21 of 143 groins (15%) had a tumour‐positive SLN. All but one patient went on to completion lymph node dissection. Three of these 18 (17%) had further disease in other than SLNs. Six of 143 (4%) groins developed minor complications. One false‐negative result was reported at a median (range) follow‐up of 11 (2–24) months. CONCLUSION This technique is feasible for managing penile cancer in a UK tertiary referral centre. The initial results suggest that it can accurately identify the SLN(s), which can then be removed for pathological review with minimal morbidity.