Near-Infrared Fluorescence Applications in Penile Cancer

  • Wojciech PolomEmail author
  • Karol Polom
  • Marcin Matuszewski


Penile cancer is a rare neoplasm with a high mortality and morbidity rate. The most common histology of this malignancy is squamous cell carcinoma, which pathologically is similar to SCC of the anus, oropharynx, vulva, cervix, and vagina. In Western countries, the incidence of this malignancy is low (1/100000 males); however, in some developing countries it poses a serious medical problem with the incidence rate reaching 10–20% of all malignancies in men. HPV-related carcinogenesis accounts for about a third of the cases. Penile carcinoma can be cured in about 80% of the cases if it is recognized early. In the case of lymphatic metastases, it can be life-threatening and so adequate treatment should be offered. A surgery including the removal of the penile tumor with lymphadenectomy is the primary treatment method for the localized disease in a select group of patients. The preoperative diagnostic evaluation of the primary lesion and lymph nodes is challenging. In many cases, penile cancer is clinically obvious. Physical examination and radiological evaluation are recommended to assess the extent of the local invasion. Moreover, palpation of both groins is performed to assess whether lymph nodes are enlarged. In the case of non-palpable inguinal nodes, the chance for micro-metastases is about 25% and imaging studies do not help in the staging of normal inguinal regions. In a select group of patients (pT1–T4) invasive lymph nodes staging is recommended. This can be performed by a dynamic sentinel lymph node biopsy or a modified inguinal lymphadenectomy. The standard procedure includes the application of a radiotracer and a hand-held gamma probe. Recently, new methods for sentinel lymph nodes detection have emerged for this malignancy including the usage of a fluorescent dye—indocyanine green—and a near-infrared camera. This technique is not a standard procedure and should not be used as the only technique for nodal detection yet.


Penile cancer Sentinel lymph node biopsy Lymphadenectomy Fluorescence Near-infrared Indocyanine green Image-guided surgery Lymph node staging 

Supplementary material

Video 24.1

ICG injection in case of penile cancer and lymphatic outflow identification (WMV 40683 kb)

Video 24.2

Lymphatic vessel identification during preparation with the use of ICG and NIRF camera (WMV 27123 kb)

Video 24.3

Excision of the sentinel lymph node identified with the use of ICG and NIRF camera (WMV 133559 kb)

Video 24.4

Use of Near-Infrared Fluorescent Camera system intraoperatively after ICG injection in case of penile cancer (MOV 60543 kb)

Video 24.5

Intraoperative identification of sentinel lymph node with the use of NIRF system and hand-held gamma probe—hybrid technique (WMV 55186 kb)


  1. 1.
    Windahl T, Andersson S-O. Combined laser treatment for penile carcinoma: results after long-term followup. J Urol. 2003;169(6):2118–21.CrossRefGoogle Scholar
  2. 2.
    Colecchia M, Nicolai N, Secchi P, Bandieramonte G, Paganoni AM, Sangalli LM, et al. pT1 penile squamous cell carcinoma: a clinicopathologic study of 56 cases treated by C02 laser therapy. Anal Quant Cytol Histol. 2009;31(3):153–60.PubMedGoogle Scholar
  3. 3.
    Zou Z-J, Liu Z-H, Tang L-Y, Wang Y-J, Liang J-Y, Zhang R-C, et al. Radiocolloid-based dynamic sentinel lymph node biopsy in penile cancer with clinically negative inguinal lymph node: an updated systematic review and meta-analysis. Int Urol Nephrol. 2016;48(12):2001–13.CrossRefGoogle Scholar
  4. 4.
    van Bezooijen BP, Horenblas S, Meinhardt W, Newling DW. Laser therapy for carcinoma in situ of the penis. J Urol. 2001;166(5):1670–1.CrossRefGoogle Scholar
  5. 5.
    Shindel AW, Mann MW, Lev RY, Sengelmann R, Petersen J, Hruza GJ, et al. Mohs micrographic surgery for penile cancer: management and long-term followup. J Urol. 2007;178(5):1980–5.CrossRefGoogle Scholar
  6. 6.
    Markuszewski M, Polom W, Cytawa W, Czapiewski P, Lass P, Matuszewski M. Comparison of real-time fluorescent indocyanine green and99mTc-nanocolloid radiotracer navigation in sentinel lymph node biopsy of penile cancer. Clin Genitourin Cancer [Internet]. 2015;13(6):574–80. Available from: Scholar
  7. 7.
    Bjurlin MA, Zhao LC, Kenigsberg AP, Mass AY, Taneja SS, Huang WC. Novel use of fluorescence lymphangiography during robotic groin dissection for penile cancer. Urology [Internet]. 2017;107:267. Available from: Scholar
  8. 8.
    Brouwer OR, Van Den Berg NS, Mathéron HM, Van Der Poel HG, Van Rhijn BW, Bex A, et al. A hybrid radioactive and fluorescent tracer for sentinel node biopsy in penile carcinoma as a potential replacement for blue dye. Eur Urol. 2014;65(3):600–9.CrossRefGoogle Scholar
  9. 9.
    Stoffels I, Leyh J, Poppel T, Schadendorf D, Klode J. Evaluation of a radioactive and fluorescent hybrid tracer for sentinel lymph node biopsy in head and neck malignancies: prospective randomized clinical trial to compare ICG-(99m)Tc-nanocolloid hybrid tracer versus (99m)Tc-nanocolloid. Eur J Nucl Med Mol Imaging. 2015;42(11):1631–8.CrossRefGoogle Scholar
  10. 10.
    Polom W, Markuszewski M, Cytawa W, Czapiewski P, Lass P, Matuszewski M. Fluorescent versus radioguided lymph node mapping in bladder cancer. Clin Genitourin Cancer [Internet]. 2017;15(3):e405–9. Available from: Scholar
  11. 11.
    Ross GL, Shoaib T, Scott J, Soutar DS, Gray HW, MacKie R. The learning curve for sentinel node biopsy in malignant melanoma. Br J Plast Surg. 2002;55(4):298–301.CrossRefGoogle Scholar
  12. 12.
    KleinJan GH, van Werkhoven E, van den Berg NS, Karakullukcu MB, Zijlmans HJMAA, van der Hage JA, et al. The best of both worlds: a hybrid approach for optimal pre- and intraoperative identification of sentinel lymph nodes. Eur J Nucl Med Mol Imaging. 2018;45(11):1915–25.CrossRefGoogle Scholar
  13. 13.
    Hope-Ross M, Yannuzzi LA, Gragoudas ES, Guyer DR, Slakter JS, Sorenson JA, et al. Adverse reactions due to indocyanine green. Ophthalmology. 1994;101(3):529–33.CrossRefGoogle Scholar
  14. 14.
    Chu W, Chennamsetty A, Toroussian R, Lau C. Anaphylactic shock after intravenous administration of indocyanine green during robotic partial nephrectomy. Urol Case Rep [Internet]. 2017;12:37–8. Available from: Scholar
  15. 15.
    Murawa D, Polom K, Murawa P. One-year postoperative morbidity associated with near-infrared-guided indocyanine green (ICG) or ICG in conjugation with human serum albumin (ICG:HSA) sentinel lymph node biopsy. Surg Innov. 2014;21(3):240–3.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Wojciech Polom
    • 1
    Email author
  • Karol Polom
    • 2
  • Marcin Matuszewski
    • 1
  1. 1.Department of UrologyMedical University of GdanskGdanskPoland
  2. 2.Department of Oncological SurgeryMedical University of GdanskGdanskPoland

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