Nodal staging in penile carcinoma by dynamic sentinel node biopsy after previous therapeutic primary tumour resection.
BACKGROUND
Dynamic sentinel node biopsy (DSNB) is used to evaluate the nodal status of patients with penile carcinoma and clinically node-negative groins. This minimally invasive procedure is usually done at the same time as the treatment of the primary tumour.


OBJECTIVE
Our aim was to evaluate results of so-called postresection DSNB, that is, DSNB after previous resection of the penile tumour.


METHODS
All 40 patients who had undergone DSNB after previous penile carcinoma resection with histopathologically tumour-negative margins between February 2003 and July 2009 were analysed. Twenty patients (50%) had known unilateral nodal involvement, and DSNB was used to stage the clinically normal contralateral groin. Hence the study concerned 60 groins without palpable nodes. The median time between primary tumour resection and DSNB was 2.8 mo. The technique of postresection DSNB was similar to the standard procedure.


METHODS
The sentinel node visualisation rate, identification rate, histopathologic results, and outcome during follow-up were investigated.


CONCLUSIONS
A sentinel node was visualised on the lymphoscintigrams of 56 of the 60 eligible groins (93%). A sentinel node was identified intraoperatively in all these 56 groins. A median of two sentinel nodes were removed. Histopathologic analysis revealed involvement of seven groins (12%) in seven patients (18%). The median size of these metastases was 6mm. Additional dissemination was found in one completed ipsilateral inguinal node dissection specimen. No recurrences developed in the groins from which one or more tumour-free sentinel nodes had been taken during a median follow-up of 28 mo after the primary tumour resection. A potential limitation of this study is the short follow-up and relatively small cohort number.


CONCLUSIONS
Postresection DSNB is a suitable procedure to stage clinically node-negative penile carcinoma after previous therapeutic primary tumour resection. The results seem similar to the favourable experience with DSNB in patients with their tumour still present.
Graafland
Niels M
NM
Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
Valdés Olmos
Renato A
RA
Meinhardt
Willem
W
Bex
Axel
A
van der Poel
Henk G
HG
van Boven
Hester H
HH
Nieweg
Omgo E
OE
Horenblas
Simon
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D010412:Penile Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery; D011184:Postoperative Period; D011877:Radionuclide Imaging; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*