Skip to main content
SpringerLink
Log in

Dynamic Sentinel Node Biopsy and FDG-PET/CT for Lymph Node Staging in Penile Cancer

  • Chapter
  • First Online:
Penile Cancer

Part of the book series: Current Clinical Urology ((CCU))

  • 770 Accesses

Abstract

Staging of inguinal nodes is pivotal for prognostication and determination of the optimal treatment in penile cancer. Current noninvasive staging tools (such as palpation, ultrasound, CT, and MRI) are not sensitive enough to detect small occult lymph node metastases in intermediate to high-risk patients, who have a chance of approximately 20 % of harboring inguinal nodal metastases. Dynamic lymphoscintigraphy with sentinel node biopsy can detect microscopic metastases, while avoiding the morbidity associated with an inguinal lymphadenectomy. If dynamic sentinel node biopsy is preceded by ultrasound with fine needle aspiration cytology for the identification of macroscopic metastases, the overall sensitivity for inguinal nodes is >90 %. If metastases are found, an inguinal lymphadenectomy should be performed. The risks of false negative results and their implications on prognosis should be discussed with the patient before deciding on which method to use (i.e., dynamic sentinel node biopsy or direct inguinal lymphadenectomy). Newer imaging modalities, such as FDG-PET/CT, are of limited use for inguinal staging but are promising for pelvic and distant staging.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 54.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Horenblas S, van Tinteren H. Squamous cell carcinoma of the penis. IV. Prognostic factors of survival: analysis of tumor, nodes and metastasis classification system. J Urol. 1994;151(5):1239–43.

    CAS  PubMed  Google Scholar 

  2. Lont AP, Kroon BK, Gallee MPW, van Tinteren H, Moonen LMF, Horenblas S. Pelvic lymph node dissection for penile carcinoma: extent of inguinal lymph node involvement as an indicator for pelvic lymph node involvement and survival. J Urol. 2007;177(3):947–52. Discussion 952.

    Article  PubMed  Google Scholar 

  3. Sánchez-Ortiz RF, Pettaway CA. The role of lymphadenectomy in penile cancer. Urol Oncol. 2004;22(3):236–44. Discussion 244–5.

    Article  PubMed  Google Scholar 

  4. Pandey D, Mahajan V, Kannan RR. Prognostic factors in node-positive carcinoma of the penis. J Surg Oncol. 2006;93(2):133–8.

    Article  PubMed  Google Scholar 

  5. Ornellas AA, Kinchin EW, Nobrega BLB, Wisnescky A, Koifman N, Quirino R. Surgical treatment of invasive squamous cell carcinoma of the penis: Brazilian National Cancer Institute long-term experience. J Surg Oncol. 2008;97(6):487–95.

    Article  PubMed  Google Scholar 

  6. Sun M, Djajadiningrat RS, Alnajjar HM, et al. Development and external validation of a prognostic tool for prediction of cancer-specific mortality after complete loco-regional pathological staging for squamous cell carcinoma of the penis. BJU Int. 2015;116(5):734–43.

    Article  PubMed  Google Scholar 

  7. Djajadiningrat RS, Graafland NM, van Werkhoven E, et al. Contemporary management of regional nodes in penile cancer-improvement of survival? J Urol. 2014;191(1):68–73.

    Article  PubMed  Google Scholar 

  8. Srinivas V, Morse MJ, Herr HW, Sogani PC, Whitmore WF. Penile cancer: relation of extent of nodal metastasis to survival. J Urol. 1987;137(5):880–2.

    CAS  PubMed  Google Scholar 

  9. Daseler EH, Anson BJ, Reimann AF. Radical excision of the inguinal and iliac lymph glands; a study based upon 450 anatomical dissections and upon supportive clinical observations. Surg Gynecol Obstet. 1948;87(6):679–94.

    CAS  PubMed  Google Scholar 

  10. Hakenberg OW, Compérat EM, Minhas S, Necchi A, Protzel C, Watkin N. EAU guidelines on penile cancer: 2014 update. Eur Urol. 2015;67(1):142–50.

    Article  PubMed  Google Scholar 

  11. Wespes E. The management of regional lymph nodes in patients with penile carcinoma and reliability of sentinel node biopsy. Eur Urol. 2007;52(1):15–6. Discussion 20–1.

    Article  PubMed  Google Scholar 

  12. Leijte JAP, Kroon BK, Valdés Olmos RA, Nieweg OE, Horenblas S. Reliability and safety of current dynamic sentinel node biopsy for penile carcinoma. Eur Urol. 2007;52(1):170–7.

    Article  PubMed  Google Scholar 

  13. Lont AP, Horenblas S, Tanis PJ, Gallee MP, van Tinteren H, Nieweg OE. Management of clinically node negative penile carcinoma: improved survival after the introduction of dynamic sentinel node biopsy. J Urol. 2003;170(3):783–6.

    Article  CAS  PubMed  Google Scholar 

  14. Ravi R. Morbidity following groin dissection for penile carcinoma. Br J Urol. 1993;72(6):941–5.

    Article  CAS  PubMed  Google Scholar 

  15. Ornellas AA, Seixas AL, de Moraes JR. Analyses of 200 lymphadenectomies in patients with penile carcinoma. J Urol. 1991;146(2):330–2.

    CAS  PubMed  Google Scholar 

  16. Bevan-Thomas R, Slaton JW, Pettaway CA. Contemporary morbidity from lymphadenectomy for penile squamous cell carcinoma: the M.D. Anderson Cancer Center Experience. J Urol. 2002;167(4):1638–42.

    Article  PubMed  Google Scholar 

  17. Stuiver MM, Djajadiningrat RS, Graafland NM, Vincent AD, Lucas C, Horenblas S. Early wound complications after inguinal lymphadenectomy in penile cancer: a historical cohort study and risk-factor analysis. Eur Urol. 2013;64(3):486–92.

    Article  PubMed  Google Scholar 

  18. Hegarty PK, Kayes O, Freeman A, Christopher N, Ralph DJ, Minhas S. A prospective study of 100 cases of penile cancer managed according to European Association of Urology guidelines. BJU Int. 2006;98(3):526–31.

    Article  PubMed  Google Scholar 

  19. Ercole CE, Pow-Sang JM, Spiess PE. Update in the surgical principles and therapeutic outcomes of inguinal lymph node dissection for penile cancer. Urol Oncol. 2013;31(5):505–16.

    Article  PubMed  Google Scholar 

  20. Horenblas S, Jansen L, Meinhardt W, Hoefnagel CA, de Jong D, Nieweg OE. Detection of occult metastasis in squamous cell carcinoma of the penis using a dynamic sentinel node procedure. J Urol. 2000;163(1):100–4.

    Article  CAS  PubMed  Google Scholar 

  21. Leijte JAP, Hughes B, Graafland NM, et al. Two-center evaluation of dynamic sentinel node biopsy for squamous cell carcinoma of the penis. J Clin Oncol. 2009;27(20):3325–9.

    Article  PubMed  Google Scholar 

  22. Cabanas RM. An approach for the treatment of penile carcinoma. Cancer. 1977;39(2):456–66.

    Article  CAS  PubMed  Google Scholar 

  23. Leijte JAP, Valdés Olmos RA, Nieweg OE, Horenblas S. Anatomical mapping of lymphatic drainage in penile carcinoma with SPECT-CT: implications for the extent of inguinal lymph node dissection. Eur Urol. 2008;54(4):885–90.

    Article  PubMed  Google Scholar 

  24. Kroon BK, Valdés Olmos RA, van der Poel HG, Nieweg OE, Horenblas S. Prepubic sentinel node location in penile carcinoma. Clin Nucl Med. 2005;30(10):649–50.

    Article  PubMed  Google Scholar 

  25. Brouwer OR, van den Berg NS, Matheron HM, 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.

    Article  CAS  PubMed  Google Scholar 

  26. Crawshaw JW, Hadway P, Hoffland D, et al. Sentinel lymph node biopsy using dynamic lymphoscintigraphy combined with ultrasound-guided fine needle aspiration in penile carcinoma. Br J Radiol. 2009;82(973):41–8.

    Article  CAS  PubMed  Google Scholar 

  27. Lam W, Alnajjar HM, La-Touche S, et al. Dynamic sentinel lymph node biopsy in patients with invasive squamous cell carcinoma of the penis: a prospective study of the long-term outcome of 500 inguinal basins assessed at a single institution. Eur Urol. 2013;63(4):657–63.

    Article  PubMed  Google Scholar 

  28. Sadeghi R, Gholami H, Zakavi SR, Kakhki VRD, Tabasi KT, Horenblas S. Accuracy of sentinel lymph node biopsy for inguinal lymph node staging of penile squamous cell carcinoma: systematic review and meta-analysis of the literature. J Urol. 2012;187(1):25–31.

    Article  PubMed  Google Scholar 

  29. d’Ancona CAL, de Lucena RG, Querne FA, Martins MHT, Denardi F, Netto NR. Long-term followup of penile carcinoma treated with penectomy and bilateral modified inguinal lymphadenectomy. J Urol. 2004;172(2):498–501. Discussion 501.

    Article  PubMed  Google Scholar 

  30. Scher B, Seitz M, Reiser M, et al. 18F-FDG PET/CT for staging of penile cancer. J Nucl Med. 2005;46(9):1460–5.

    PubMed  Google Scholar 

  31. Schlenker B, Scher B, Tiling R, et al. Detection of inguinal lymph node involvement in penile squamous cell carcinoma by 18F-fluorodeoxyglucose PET/CT: a prospective single-center study. Urol Oncol. 2012;30(1):55–9.

    Article  PubMed  Google Scholar 

  32. Souillac I, Rigaud J, Ansquer C, Marconnet L, Bouchot O. Prospective evaluation of (18)F-fluorodeoxyglucose positron emission tomography-computerized tomography to assess inguinal lymph node status in invasive squamous cell carcinoma of the penis. J Urol. 2012;187(2):493–7.

    Article  PubMed  Google Scholar 

  33. Leijte JAP, Graafland NM, Valdés Olmos RA, van Boven HH, Hoefnagel CA, Horenblas S. Prospective evaluation of hybrid 18F-fluorodeoxyglucose positron emission tomography/computed tomography in staging clinically node-negative patients with penile carcinoma. BJU Int. 2009;104(5):640–4.

    Article  PubMed  Google Scholar 

  34. Graafland NM, Leijte JAP, Valdés Olmos RA, Hoefnagel CA, Teertstra HJ, Horenblas S. Scanning with 18F-FDG-PET/CT for detection of pelvic nodal involvement in inguinal node-positive penile carcinoma. Eur Urol. 2009;56(2):339–45.

    Article  PubMed  Google Scholar 

  35. Sadeghi R, Gholami H, Zakavi SR, Kakhki VRD, Horenblas S. Accuracy of 18F-FDG PET/CT for diagnosing inguinal lymph node involvement in penile squamous cell carcinoma: systematic review and meta-analysis of the literature. Clin Nucl Med. 2012;37(5):436–41.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Plesmanlaan 121, Amsterdam, 1066 CX, The Netherlands

    Niels M. Graafland M.D., Ph.D. & Sarah R. Ottenhof M.D., M.Sc.

  2. Nuclear Medicine Section & Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Centre, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands

    Renato A. Valdés Olmos M.D., Ph.D.

  3. Department of Nuclear Medicine, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Plesmanlaan 121, Amsterdam, 1066 CX, The Netherlands

    Erik Vegt M.D., Ph.D.

Authors
  1. Niels M. Graafland M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sarah R. Ottenhof M.D., M.Sc.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Renato A. Valdés Olmos M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Erik Vegt M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Erik Vegt M.D., Ph.D. .

Editor information

Editors and Affiliations

  1. Department of Genitourinary Oncology, Department of Tumor Biology, Moffitt Cancer Center, Tampa, Florida, USA

    Philippe E. Spiess

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer Science+Business Media LLC

About this chapter

Cite this chapter

Graafland, N.M., Ottenhof, S.R., Olmos, R.A.V., Vegt, E. (2017). Dynamic Sentinel Node Biopsy and FDG-PET/CT for Lymph Node Staging in Penile Cancer. In: Spiess, P. (eds) Penile Cancer. Current Clinical Urology. Humana Press, New York, NY. https://doi.org/10.1007/978-1-4939-6679-0_4

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-6679-0_4

  • Published:

  • Publisher Name: Humana Press, New York, NY

  • Print ISBN: 978-1-4939-6677-6

  • Online ISBN: 978-1-4939-6679-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation