Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.
BJU Int. 2010 Apr;105(8):1121-4. doi: 10.1111/j.1464-410X.2009.08894.x. Epub 2009 Oct 10.
To explore the role of repeat dynamic sentinel-node biopsy (SNB) in clinically node-negative patients with locally recurrent penile carcinoma after previous penile surgery and SNB.
Between 1994 and 2008, 12 patients (4% of the 304 in our prospectively maintained dynamic sentinel node database) with clinically node-negative groins had a repeat SNB for locally recurrent penile carcinoma after previous penile surgery and SNB. Five of these patients had previously had a unilateral inguinal node dissection for groin metastases. The median disease-free interval was 18 months. The protocol and technique of primary dynamic SNB and the repeat procedure were similar, including preoperative lymphoscintigraphy and blue-dye injection. Completion inguinal node dissection was only done if there was an involved sentinel node.
No sentinel nodes were seen on preoperative lymphoscintigraphy in the five groins that had previously been dissected. A sentinel node was visualized on lymphoscintigraphy in the remaining 19 undissected groins. In 15 of these groins (79%) the sentinel node was identified during surgery. Histopathological analysis showed involved sentinel nodes in four groins of three patients. Additional metastatic nodes were found in one completion inguinal lymph node dissection specimen. During a median follow-up of 32 months after the repeat SNB, one patient developed a groin recurrence 14 months after a tumour-negative sentinel node procedure.
Repeat dynamic SNB is feasible in clinically node-negative patients with locally recurrent penile carcinoma despite previous SNB.
探讨重复动态前哨淋巴结活检（SNB）在既往阴茎手术和 SNB 后临床淋巴结阴性局部复发性阴茎癌患者中的作用。
1994 年至 2008 年间，在我们前瞻性维护的动态前哨淋巴结数据库中，304 例患者中有 12 例（4%）在既往阴茎手术和 SNB 后局部复发性阴茎癌且临床淋巴结阴性的腹股沟接受重复 SNB。其中 5 例患者既往因腹股沟转移而行单侧腹股沟淋巴结清扫术。无病间隔中位数为 18 个月。初次动态 SNB 和重复手术的方案和技术相似，包括术前淋巴闪烁显像和蓝染注射。如果存在受累的前哨淋巴结，则仅行完成的腹股沟淋巴结清扫术。
在之前已行清扫的 5 个腹股沟中，术前淋巴闪烁显像未见前哨淋巴结。在其余 19 个未行清扫的腹股沟中，有 19 个显示淋巴闪烁显像。在这 19 个腹股沟中，有 15 个（79%）在手术中识别出前哨淋巴结。组织病理学分析显示 3 例患者的 4 个腹股沟中有受累的前哨淋巴结。在 1 例完成的腹股沟淋巴结清扫标本中发现了额外的转移性淋巴结。在重复 SNB 后的中位随访 32 个月期间，1 例肿瘤阴性前哨淋巴结手术后 14 个月出现腹股沟复发。
尽管有既往 SNB，重复动态 SNB 在临床淋巴结阴性的局部复发性阴茎癌患者中是可行的。
