title: Repeat dynamic sentinel node biopsy in locally recurrent penile carcinoma.
abstract: OBJECTIVE
  To explore the role of repeat dynamic sentinel-node biopsy (SNB) in clinically node-negative patients with locally recurrent penile carcinoma after previous penile surgery and SNB.
  
  
  METHODS
  Between 1994 and 2008, 12 patients (4% of the 304 in our prospectively maintained dynamic sentinel node database) with clinically node-negative groins had a repeat SNB for locally recurrent penile carcinoma after previous penile surgery and SNB. Five of these patients had previously had a unilateral inguinal node dissection for groin metastases. The median disease-free interval was 18 months. The protocol and technique of primary dynamic SNB and the repeat procedure were similar, including preoperative lymphoscintigraphy and blue-dye injection. Completion inguinal node dissection was only done if there was an involved sentinel node.
  
  
  RESULTS
  No sentinel nodes were seen on preoperative lymphoscintigraphy in the five groins that had previously been dissected. A sentinel node was visualized on lymphoscintigraphy in the remaining 19 undissected groins. In 15 of these groins (79%) the sentinel node was identified during surgery. Histopathological analysis showed involved sentinel nodes in four groins of three patients. Additional metastatic nodes were found in one completion inguinal lymph node dissection specimen. During a median follow-up of 32 months after the repeat SNB, one patient developed a groin recurrence 14 months after a tumour-negative sentinel node procedure.
  
  
  CONCLUSIONS
  Repeat dynamic SNB is feasible in clinically node-negative patients with locally recurrent penile carcinoma despite previous SNB.
authors.affiliation: Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.
authors.forename: Niels M
authors.initials: NM
authors.lastname: Graafland
authors.forename: Joost A P
authors.initials: JA
authors.lastname: Leijte
authors.forename: Renato A Valdés
authors.initials: RA
authors.lastname: Olmos
authors.forename: Hester H
authors.initials: HH
authors.lastname: Van Boven
authors.forename: Omgo E
authors.initials: OE
authors.lastname: Nieweg
authors.forename: Simon
authors.initials: S
authors.lastname: Horenblas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005240:Feasibility Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000601:surgery; D009367:Neoplasm Staging / Q000379:methods; D010412:Penile Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D011446:Prospective Studies; D011877:Radionuclide Imaging; D012086:Reoperation; D021701:Sentinel Lymph Node Biopsy / Q000379:methods