Predicting pelvic lymph node metastases in penile cancer patients: a comparison of computed tomography, Cloquet's node, and disease burden of inguinal lymph nodes.
BACKGROUND
The aim of this study was to evaluate the role of computed tomography (CT), Cloquet's node, and disease burden of inguinal lymph nodes (LNs) in predicting pelvic lymph node metastases (LNM) of penile cancer.


METHODS
Bilateral inguinal lymph node dissection was performed in 73 penile cancer patients and revealed that 33 groin basins exhibited inguinal LNM.


RESULTS
Of the 33 groin basins, 16 (48.5%) had pelvic LNM. The sensitivity of pelvic CT in detecting metastatic LNs was 37.5%, and the specificity was 100%. Cloquet's node had a sensitivity of 30.0% and a specificity of 94.1% in pelvic CT-negative groin basins. Pathological characteristics of the inguinal LNs - number of positive LNs, lymph node ratio (number of positive LNs/total number removed), extranodal extension and the expression of p53 - were significantly associated with pelvic LNM. Furthermore, enlarged inguinal LNs = 3 in preoperative CT imaging and lymph node size = 3.5 cm in long diameter were prognostic factors for pelvic LNM (p = 0.001 and 0.003, respectively).


CONCLUSIONS
Pelvic CT imaging and tumor status of Cloquet's node is of limited use in predicting microscopic pelvic LNM. Pathological characteristics of the inguinal LNs remain the essential indicators of pelvic LNM.
Zhu
Yao
Y
Department of Urology, Cancer Hospital, Fudan University, Fudan University, Shanghai, China.
Zhang
Shi Lin
SL
Ye
Ding Wei
DW
Yao
Xu Dong
XD
Jiang
Zhao Xia
ZX
Zhou
Xiao Yan
XY
D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D007264:Inguinal Canal; D019394:Ki-67 Antigen / Q000032:analysis; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D010388:Pelvis; D010412:Penile Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D010413:Penis / Q000473:pathology / Q000601:surgery; D021701:Sentinel Lymph Node Biopsy; D036542:Tomography, Spiral Computed; D047368:Tumor Burden; D016159:Tumor Suppressor Protein p53 / Q000032:analysis
D019394:Ki-67 Antigen; D016159:Tumor Suppressor Protein p53