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

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Part of the Current Clinical Urology book series (CCU)

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.

Keywords

  • Inguinal staging
  • Sentinel node biopsy (dynamic, DSNB)
  • Single photon emission computed tomography (SPECT)
  • Fluorodeoxyglucose (FDG)
  • Positron emission tomography (PET)

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

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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

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

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  • Publisher Name: Humana Press, New York, NY

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