Perdonà Sisto, Autorino Riccardo, De Sio Marco, Di Lorenzo Giuseppe, Gallo Luigi, Damiano Rocco, D'Armiento Massimo, Gallo Antonio
Department of Urology, National Cancer Institute, Naples, Italy.
Urology. 2005 Dec;66(6):1282-6. doi: 10.1016/j.urology.2005.06.085.
To evaluate the reliability and morbidity of dynamic sentinel node biopsy compared with radical inguinal lymphadenectomy (RIL) in the treatment of selected patients with squamous cell penile carcinoma.
We retrospectively considered patients with clinically node-negative Stage pT2-pT3 penile cancer. From 1994 to 2000, 48 patients (group 1, mean age 63 years) underwent penectomy and, after 4 weeks, prophylactic bilateral RIL. From 2001 to 2004, 22 patients (group 2, mean age 67 years) underwent penectomy and dynamic sentinel node biopsy. After 4 weeks, bilateral RIL was performed.
In group 1, nodal disease was found in 39.6% of the patients. Early complications occurred in 21 patients (47.5%), with the most common being seroma formation. Late complications occurred in 18 patients (37.5%), with the most common being leg edema. In group 2, preoperative lymphoscintigraphy revealed no sentinel nodes in 1 patient, unilateral sentinel nodes in 7, and bilateral nodes in 14. A total of 35 sentinel nodes were seen in 42 inguinal regions (mean 0.83), including 27 (77.2%) identified with the probe and blue dye and 8 (22.8%) located with the probe only. Metastases were noted in 8 (36.4%) of 22 patients, bilaterally in 4 of them. Early minor complications occurred in 3 patients (13.6%). The technique had an 89% negative predictive value and 90% sensitivity.
The results of this study have shown that dynamic sentinel node biopsy is a minimally invasive technique that is easy to perform, with similar results to those of RIL, but lower morbidity. This procedure offers the possibility of less-extensive surgery for clinically node-negative penile carcinoma.
评估动态前哨淋巴结活检术与根治性腹股沟淋巴结清扫术（RIL）在治疗特定鳞状细胞阴茎癌患者中的可靠性及发病率。
我们回顾性分析了临床淋巴结阴性的pT2 - pT3期阴茎癌患者。1994年至2000年，48例患者（第1组，平均年龄63岁）接受了阴茎切除术，4周后进行双侧预防性RIL。2001年至2004年，22例患者（第2组，平均年龄67岁）接受了阴茎切除术及动态前哨淋巴结活检。4周后进行双侧RIL。
第1组中，39.6%的患者发现有淋巴结疾病。21例患者（47.5%）出现早期并发症，最常见的是血清肿形成。18例患者（37.5%）出现晚期并发症，最常见的是腿部水肿。第2组中，术前淋巴闪烁显像显示1例患者无前哨淋巴结，7例有单侧前哨淋巴结，14例有双侧前哨淋巴结。42个腹股沟区域共发现35个前哨淋巴结（平均0.83个），其中27个（77.2%）通过探针和蓝色染料识别，8个（22.8%）仅通过探针定位。22例患者中有8例（36.4%）发现转移，其中4例为双侧转移。3例患者（13.6%）出现早期轻微并发症。该技术的阴性预测值为89%，敏感性为90%。
本研究结果表明，动态前哨淋巴结活检是一种易于实施的微创技术，结果与RIL相似，但发病率较低。该手术为临床淋巴结阴性的阴茎癌患者提供了进行范围较小手术的可能性。
