Leijte Joost A P, Valdés Olmos Renato A, Nieweg Omgo E, Horenblas Simon
Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 21, Amsterdam, The Netherlands.
Eur Urol. 2008 Oct;54(4):885-90. doi: 10.1016/j.eururo.2008.04.094. Epub 2008 May 19.
Knowledge regarding the lymphatic drainage pattern of penile cancer is the basis for the extent of inguinal lymph node dissection for this disease.
To prospectively analyze the lymphatic drainage pattern of penile carcinoma using SPECT-CT and evaluate the implications for the extent of inguinal lymph node dissection.
DESIGN, SETTING, AND PARTICIPANTS: The lymphatic drainage patterns of 50 patients scheduled for dynamic sentinel node biopsy were analyzed using a hybrid SPECT-CT scanner.
A total of 86 clinically node-negative (cN0) inguinal and pelvic regions was evaluated. The sentinel and higher-tier nodes on SPECT-CT were divided into different zones in the groin and pelvic region. The groin was divided according to Daseler's five zones, four zones obtained by drawing a vertical and horizontal line over the saphenofemoral junction and one zone directly overlying this junction. The nodes in the pelvic region were classified into three zones: the external iliac/obturator zone, the common iliac zone, and the paraaortal zone.
Lymphatic drainage was visualised in 82 of the 86 cN0 groins (95.3%). A total of 115 sentinel nodes and 182 higher-tier nodes was found. All sentinel nodes were located in superior and central inguinal zones. The higher-tier nodes were located in the groin and pelvic region. No lymphatic drainage was seen to the inferior two regions of the groin. A potential limitation of the study is that the unilateral lymphatic drainage seen in some patients could be normal, but it could also be caused by blockage of lymphatic drainage due to a grossly involved metastatic lymph node. Another possible limitation is that this study relies on the quality and accuracy of lymphoscintigraphy and the subsequent sentinel node procedure.
All sentinel and higher-tier nodes were located in the superior and central inguinal zones and the pelvic region. No lymphatic drainage to the inferior inguinal zones was seen. This suggests that the extent of inguinal node dissection in cN0 patients could be reduced to removal of the superior and central inguinal zones. This may decrease the extensive morbidity associated with this procedure.
阴茎癌淋巴引流模式的相关知识是确定该疾病腹股沟淋巴结清扫范围的基础。
采用SPECT-CT前瞻性分析阴茎癌的淋巴引流模式，并评估其对腹股沟淋巴结清扫范围的意义。
设计、场所和参与者：使用混合SPECT-CT扫描仪分析50例计划进行动态前哨淋巴结活检患者的淋巴引流模式。
共评估了86个临床淋巴结阴性（cN0）的腹股沟和盆腔区域。SPECT-CT上的前哨淋巴结和更高一级淋巴结被分为腹股沟和盆腔区域的不同区域。腹股沟根据达塞勒的五个区域进行划分，通过在股隐静脉交界处绘制一条垂直线和一条水平线得到四个区域，以及一个直接位于该交界处上方的区域。盆腔区域的淋巴结分为三个区域：髂外/闭孔区、髂总区和腹主动脉旁区。
86个cN0腹股沟区中有82个（95.3%）可见淋巴引流。共发现115个前哨淋巴结和182个更高一级淋巴结。所有前哨淋巴结均位于腹股沟上区和中区。更高一级淋巴结位于腹股沟和盆腔区域。腹股沟下方两个区域未见淋巴引流。该研究的一个潜在局限性是，一些患者中观察到的单侧淋巴引流可能是正常的，但也可能是由于转移淋巴结严重受累导致淋巴引流受阻所致。另一个可能的局限性是，本研究依赖于淋巴闪烁显像和随后的前哨淋巴结手术的质量和准确性。
所有前哨淋巴结和更高一级淋巴结均位于腹股沟上区和中区以及盆腔区域。未见腹股沟下区有淋巴引流。这表明cN0患者的腹股沟淋巴结清扫范围可缩小至切除腹股沟上区和中区。这可能会降低与此手术相关的广泛发病率。
