Reliability of radioisotope-guided sentinel lymph node biopsy in penile cancer: verification in consideration of the European guidelines
Identifieur interne : 001897 ( Main/Curation ); précédent : 001896; suivant : 001898Reliability of radioisotope-guided sentinel lymph node biopsy in penile cancer: verification in consideration of the European guidelines
Auteurs : Tim Schubert [Allemagne] ; Jens Uphoff [Allemagne] ; Rolf-Peter Henke [Allemagne] ; Friedhelm Wawroschek [Allemagne] ; Alexander Winter [Allemagne]Source :
- BMC Urology [ 1471-2490 ] ; 2015.
Abstract
Lymph node (LN) staging in penile cancer has strong prognostic implications. This contrasts with the high morbidity of extended inguinal LN dissection (LND) or over-treatment of many patients. Therefore, inguinal dynamic sentinel node biopsy (DSNB) or modified LND is recommended by the European Association of Urology (EAU) guidelines to evaluate the nodal status of patients with clinically node-negative penile cancer. This study analyzed the reliability and morbidity of radioguided DSNB in penile cancer under consideration of the current EAU recommendations in an experienced center with long-term follow-up.
Thirty-four patients who received primary surgery and had radioguided inguinal DSNB for penile cancer (≥T1G2) were included (July 2004 to July 2013). Preoperative sentinel LN (SLN) mapping was performed using lymphoscintigraphy after peritumoral injection of 99mTechnetium nanocolloid on the day of surgery. During surgery, SLNs were detected using a gamma probe. According to the EAU guidelines, a secondary ipsilateral radical inguinal LND was performed in patients who had positive SLNs. The false-negative and complication rates of DSNB were assessed.
A total of 32 patients were analyzed. Two patients were lost to follow-up. A total of 166 SLNs (median, 5; range, 1–15) were removed and 216 LNs (SLNs + non-SLNs; median, 6; range, 2–19) were dissected. LN metastases were found in five of the 32 (15.6 %) patients and nine of the 166 (5.4 %) SLNs were found to contain metastases. None of the remaining 50 non-SLNs contained metastases. In only one of the five SLN-positive patients, a singular further metastasis was detected by secondary radical inguinal LND. During follow-up (median, 30.5; range, 5–95 months) no inguinal nodal recurrence was detected. DSNB-related complications occurred in 11.1 % of explored groins.
Radioguided DSNB is a suitable procedure for LN staging in penile cancer considering the EAU recommendations and with the required experience. Under these circumstances, patients can be spared from higher morbidity without compromising the detection of LN metastases or therapeutic implications. Improvement of the methodology used to perform DSNB should be developed further to decrease the risk of missing LN metastases and to simplify the procedure.
Url:
DOI: 10.1186/s12894-015-0093-7
PubMed: 26416391
PubMed Central: 4587800
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Oldenburg</wicri:noRegion><wicri:noRegion>26133 Oldenburg</wicri:noRegion><wicri:noRegion>26133 Oldenburg</wicri:noRegion></affiliation></author><author><name sortKey="Uphoff, Jens" sort="Uphoff, Jens" uniqKey="Uphoff J" first="Jens" last="Uphoff">Jens Uphoff</name><affiliation wicri:level="1"><nlm:aff id="Aff1">University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Rahel-Straus-Straße 10, 26133 Oldenburg, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Rahel-Straus-Straße 10, 26133 Oldenburg</wicri:regionArea><wicri:noRegion>26133 Oldenburg</wicri:noRegion><wicri:noRegion>26133 Oldenburg</wicri:noRegion><wicri:noRegion>26133 Oldenburg</wicri:noRegion></affiliation></author><author><name sortKey="Henke, Rolf Peter" sort="Henke, Rolf Peter" uniqKey="Henke R" first="Rolf-Peter" last="Henke">Rolf-Peter Henke</name><affiliation wicri:level="1"><nlm:aff id="Aff2">Oldenburg Institute of Pathology, Taubenstraße 28, 26122 Oldenburg, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Oldenburg Institute of Pathology, Taubenstraße 28, 26122 Oldenburg</wicri:regionArea><wicri:noRegion>26122 Oldenburg</wicri:noRegion><wicri:noRegion>26122 Oldenburg</wicri:noRegion><wicri:noRegion>26122 Oldenburg</wicri:noRegion></affiliation></author><author><name sortKey="Wawroschek, Friedhelm" sort="Wawroschek, Friedhelm" uniqKey="Wawroschek F" first="Friedhelm" last="Wawroschek">Friedhelm Wawroschek</name><affiliation wicri:level="1"><nlm:aff id="Aff1">University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Rahel-Straus-Straße 10, 26133 Oldenburg, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Rahel-Straus-Straße 10, 26133 Oldenburg</wicri:regionArea><wicri:noRegion>26133 Oldenburg</wicri:noRegion><wicri:noRegion>26133 Oldenburg</wicri:noRegion><wicri:noRegion>26133 Oldenburg</wicri:noRegion></affiliation></author><author><name sortKey="Winter, Alexander" sort="Winter, Alexander" uniqKey="Winter A" first="Alexander" last="Winter">Alexander Winter</name><affiliation wicri:level="1"><nlm:aff id="Aff1">University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Rahel-Straus-Straße 10, 26133 Oldenburg, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Rahel-Straus-Straße 10, 26133 Oldenburg</wicri:regionArea><wicri:noRegion>26133 Oldenburg</wicri:noRegion><wicri:noRegion>26133 Oldenburg</wicri:noRegion><wicri:noRegion>26133 Oldenburg</wicri:noRegion></affiliation></author></analytic><series><title level="j">BMC Urology</title><idno type="eISSN">1471-2490</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Lymph node (LN) staging in penile cancer has strong prognostic implications. This contrasts with the high morbidity of extended inguinal LN dissection (LND) or over-treatment of many patients. Therefore, inguinal dynamic sentinel node biopsy (DSNB) or modified LND is recommended by the European Association of Urology (EAU) guidelines to evaluate the nodal status of patients with clinically node-negative penile cancer. This study analyzed the reliability and morbidity of radioguided DSNB in penile cancer under consideration of the current EAU recommendations in an experienced center with long-term follow-up.</p></sec><sec><title>Methods</title><p>Thirty-four patients who received primary surgery and had radioguided inguinal DSNB for penile cancer (≥T1G2) were included (July 2004 to July 2013). Preoperative sentinel LN (SLN) mapping was performed using lymphoscintigraphy after peritumoral injection of <sup>99m</sup>Technetium nanocolloid on the day of surgery. During surgery, SLNs were detected using a gamma probe. According to the EAU guidelines, a secondary ipsilateral radical inguinal LND was performed in patients who had positive SLNs. The false-negative and complication rates of DSNB were assessed.</p></sec><sec><title>Results</title><p>A total of 32 patients were analyzed. Two patients were lost to follow-up. A total of 166 SLNs (median, 5; range, 1–15) were removed and 216 LNs (SLNs + non-SLNs; median, 6; range, 2–19) were dissected. LN metastases were found in five of the 32 (15.6 %) patients and nine of the 166 (5.4 %) SLNs were found to contain metastases. None of the remaining 50 non-SLNs contained metastases. In only one of the five SLN-positive patients, a singular further metastasis was detected by secondary radical inguinal LND. During follow-up (median, 30.5; range, 5–95 months) no inguinal nodal recurrence was detected. DSNB-related complications occurred in 11.1 % of explored groins.</p></sec><sec><title>Discussion and Conclusions</title><p>Radioguided DSNB is a suitable procedure for LN staging in penile cancer considering the EAU recommendations and with the required experience. Under these circumstances, patients can be spared from higher morbidity without compromising the detection of LN metastases or therapeutic implications. Improvement of the methodology used to perform DSNB should be developed further to decrease the risk of missing LN metastases and to simplify the procedure.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Horenblas, S" uniqKey="Horenblas S">S Horenblas</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Djajadiningrat, Rs" uniqKey="Djajadiningrat R">RS Djajadiningrat</name></author><author><name sortKey="Graafland, Nm" uniqKey="Graafland N">NM Graafland</name></author><author><name sortKey="Van Werkhoven, E" uniqKey="Van Werkhoven E">E van Werkhoven</name></author><author><name sortKey="Meinhardt, W" uniqKey="Meinhardt W">W Meinhardt</name></author><author><name sortKey="Bex, A" uniqKey="Bex A">A Bex</name></author><author><name sortKey="Van Der Poel, Hg" uniqKey="Van Der Poel H">HG van der Poel</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kroon, Bk" 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uniqKey="Tanis P">PJ Tanis</name></author><author><name sortKey="Lont, Ap" uniqKey="Lont A">AP Lont</name></author><author><name sortKey="Meinhardt, W" uniqKey="Meinhardt W">W Meinhardt</name></author><author><name sortKey="Olmos, Ra" uniqKey="Olmos R">RA Olmos</name></author><author><name sortKey="Nieweg, Oe" uniqKey="Nieweg O">OE Nieweg</name></author><author><name sortKey="Horenblas, S" uniqKey="Horenblas S">S Horenblas</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Jensen, Jb" uniqKey="Jensen J">JB Jensen</name></author><author><name sortKey="Jensen, Km" uniqKey="Jensen K">KM Jensen</name></author><author><name sortKey="Ulh I, Bp" uniqKey="Ulh I B">BP Ulhøi</name></author><author><name sortKey="Nielsen, Ss" uniqKey="Nielsen S">SS Nielsen</name></author><author><name sortKey="Lundbeck, F" uniqKey="Lundbeck F">F Lundbeck</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kroon, Bk" uniqKey="Kroon B">BK Kroon</name></author><author><name sortKey="Horenblas, S" uniqKey="Horenblas S">S Horenblas</name></author><author><name sortKey="Estourgie, Sh" uniqKey="Estourgie S">SH Estourgie</name></author><author><name sortKey="Lont, Ap" uniqKey="Lont A">AP Lont</name></author><author><name sortKey="Valdes Olmos, Ra" uniqKey="Valdes Olmos R">RA Valdés Olmos</name></author><author><name sortKey="Nieweg, Oe" uniqKey="Nieweg O">OE Nieweg</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Morgan Parkes, Jh" uniqKey="Morgan Parkes J">JH Morgan-Parkes</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sadeghi, R" uniqKey="Sadeghi R">R Sadeghi</name></author><author><name sortKey="Gholami, H" uniqKey="Gholami H">H Gholami</name></author><author><name sortKey="Zakavi, Sr" uniqKey="Zakavi S">SR Zakavi</name></author><author><name sortKey="Kakhki, Vr" uniqKey="Kakhki V">VR Kakhki</name></author><author><name sortKey="Tabasi, Kt" uniqKey="Tabasi K">KT Tabasi</name></author><author><name sortKey="Horenblas, S" uniqKey="Horenblas S">S Horenblas</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kroon, Bk" uniqKey="Kroon B">BK Kroon</name></author><author><name sortKey="Horenblas, S" uniqKey="Horenblas S">S Horenblas</name></author><author><name sortKey="Meinhardt, W" uniqKey="Meinhardt W">W Meinhardt</name></author><author><name sortKey="Van Der Poel, Hg" uniqKey="Van Der Poel H">HG van der Poel</name></author><author><name sortKey="Bex, A" uniqKey="Bex A">A Bex</name></author><author><name sortKey="Van Tinteren, H" uniqKey="Van Tinteren H">H van Tinteren</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Neto, As" uniqKey="Neto A">AS Neto</name></author><author><name sortKey="Tobias Machado, M" uniqKey="Tobias Machado M">M Tobias-Machado</name></author><author><name sortKey="Ficarra, V" uniqKey="Ficarra V">V Ficarra</name></author><author><name sortKey="Wroclawski, Ml" uniqKey="Wroclawski M">ML Wroclawski</name></author><author><name sortKey="Amarante, Rd" uniqKey="Amarante R">RD Amarante</name></author><author><name sortKey="Pompeo, Ac" uniqKey="Pompeo A">AC Pompeo</name></author></analytic></biblStruct></listBibl></div1></back></TEI></record>Pour manipuler ce document sous Unix (Dilib)
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