title: Value and efficiency of sentinel lymph node diagnostics in patients with penile carcinoma with palpable inguinal lymph nodes as a new multimodal, minimally invasive approach.
abstract: OBJECTIVE
  The international guidelines recommend sentinel lymph node biopsy (SLNB) for lymph node staging in penile cancer with non-palpable inguinal lymph nodes (LN) but it is not recommended with palpable inguinal LN. The aim of this study was to evaluate the reliability and morbidity of SLNB in combination with an ultrasound-guided resection of suspect inguinal LNs as a new multimodal, minimally invasive staging approach in these patients.
  
  
  METHODS
  We performed SLNB in 26 penile cancer patients with 42 palpable inguinal LNs. Prior to the combined staging procedures the patients underwent an ultrasound examination of the groins as well as planar lymphatic drainage scintigraphy and SPECT/CT scans. During the surgical procedure, the radioactive-labelled sentinel lymph nodes and, in addition, sonographically suspect LNs, were resected under ultrasound guidance. Follow-up screening was done by ultrasound examination of the groins according to the guidelines of the European Association of Urology.
  
  
  RESULTS
  Nineteen groins of 42 preoperatively palpable inguinal findings were histologically tumor-positive. SLNB alone showed lymphogenic metastases in 14 groins. Sonography revealed five further metastatic groins, which would not have been detected during SLNB due to a tumor-related blockage of lymphatic drainage or a so-called re-routing of the tracer. During follow-up, none of the 28 groins with tumor-negative LN status showed any LN recurrence in this combined investigation technique. The median follow-up period was 46 (24 to 92) months. Morbidity of this procedure was low at 4.76 % in relation to the number of groins resp. 7.69 % in relation to the number of patients.
  
  
  CONCLUSIONS
  The results show that this combined procedure is a reliable multimodal diagnostic approach for treatment of penile cancer patients with palpable inguinal LNs. It is associated with low morbidity rates. SLNB alone would lead to a significantly higher false-negative rate in these patients. The encouraging results of this work can extend the range of indications for nuclear medicine in the form of SLNB using radioactive tracers in this patient group.
authors: Department of Nuclear Medicine, Molecular Imaging Diagnostics and Therapy, University Hospital Schleswig Holstein, Campus Kiel, Feldstr. 21 (Haus 50), D-24105, Kiel, Germany. uluetzen@nuc-med.uni-kiel.de.
authors: Ulf
authors: U
authors: Lützen
authors: Department of Nuclear Medicine, Molecular Imaging Diagnostics and Therapy, University Hospital Schleswig Holstein, Campus Kiel, Feldstr. 21 (Haus 50), D-24105, Kiel, Germany.
authors: Maaz
authors: M
authors: Zuhayra
authors: Department of Nuclear Medicine, Molecular Imaging Diagnostics and Therapy, University Hospital Schleswig Holstein, Campus Kiel, Feldstr. 21 (Haus 50), D-24105, Kiel, Germany.
authors: Marlies
authors: M
authors: Marx
authors: Department of Nuclear Medicine, Molecular Imaging Diagnostics and Therapy, University Hospital Schleswig Holstein, Campus Kiel, Feldstr. 21 (Haus 50), D-24105, Kiel, Germany.
authors: Yi
authors: Y
authors: Zhao
authors: Department of Urology and Pediatric Urology, University Hospital Schleswig Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 18, D-24105, Kiel, Germany.
authors: Christian
authors: C
authors: Colberg
authors: Department of Urology and Pediatric Urology, University Hospital Schleswig Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 18, D-24105, Kiel, Germany.
authors: Stephanie
authors: S
authors: Knüpfer
authors: Department of Radio Oncology, University Hospital Schleswig Holstein, Campus Kiel, Feldstr. 21 (Haus 50), D-24105, Kiel, Germany.
authors: René
authors: R
authors: Baumann
authors: Department of Dermatology, Venerology and Allergology, University Hospital Schleswig Holstein, Campus Kiel, Schittenhelmstr. 7, D-24105, Kiel, Germany.
authors: Katharina Charlotte
authors: KC
authors: Kähler
authors: Department of Urology and Pediatric Urology, University Hospital Schleswig Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 18, D-24105, Kiel, Germany.
authors: Klaus-Peter
authors: KP
authors: Jünemann
authors: Department of Urology and Pediatric Urology, University Hospital Schleswig Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 18, D-24105, Kiel, Germany.
authors: Carsten Maik
authors: CM
authors: Naumann
mesh_terms: D000328:Adult; D000368:Aged; D006801:Humans; D007264:Inguinal Canal / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis; D061305:Lymphoscintigraphy / Q000379:methods; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D064847:Multimodal Imaging / Q000379:methods*; D009367:Neoplasm Staging; D010173:Palpation; D010412:Penile Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D000071036:Sentinel Lymph Node / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D021701:Sentinel Lymph Node Biopsy; D000072098:Single Photon Emission Computed Tomography Computed Tomography / Q000379:methods; D015996:Survival Rate; D014463:Ultrasonography / Q000379:methods
keywords: Lymph node staging; Penile cancer; SPECT/CT; Sentinel lymph node; Sonography; Tc 99 m-nanocolloid