Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
J Urol. 2011 Mar;185(3):881-7. doi: 10.1016/j.juro.2010.10.058. Epub 2011 Jan 15.
Patients with penile carcinoma, and 3 or more histopathologically proven unilateral metastatic inguinal nodes, and/or extranodal extension, and/or pelvic metastasis are considered a subgroup with prognostically unfavorable parameters for disease specific death and local recurrence after inguinal lymphadenectomy. We established radiographic criteria for the preoperative identification of such patients.
Preoperative diagnostic computerized tomography studies of 30 patients with penile carcinoma with proven unilateral or bilateral lymph node metastasis were reviewed independently by 2 radiologists blinded for patient data. All computerized tomography images were analyzed per side (60). Several radiographic criteria were assessed for regional lymph nodes with short-axis diameter 8 mm or greater and/or central nodal necrosis. Sides were characterized as high risk if histopathology revealed 3 or more metastatic inguinal nodes and/or extranodal extension and/or pelvic nodal involvement.
Histopathological nodal involvement was found in 38 sides (63%) including 22 sides (37%) defined as high risk. The presence of central nodal necrosis and/or irregular nodal border of the regional lymph nodes on the preoperative computerized tomography identified the high risk subgroup with a sensitivity of 95% (21 of 22) and a specificity of 82% (31 of 38). All 7 sides falsely designated as high risk harbored inguinal metastases but they were classified as low risk. The interobserver agreement of each radiographic parameter was almost perfect.
The presence of central nodal necrosis and/or an irregular nodal border of the regional lymph nodes on preoperative computerized tomography images are accurate and reproducible criteria to identify high risk pathological node positive penile cancer. These criteria can be used for risk stratification and patient counseling.
对于患有阴茎癌且 3 个或更多经组织病理学证实的单侧转移性腹股沟淋巴结、和/或淋巴结外侵犯、和/或骨盆转移的患者，被认为是腹股沟淋巴结清扫术后疾病特异性死亡和局部复发预后不良的亚组。我们建立了术前识别此类患者的影像学标准。
回顾性分析了 30 例经证实患有单侧或双侧淋巴结转移的阴茎癌患者的术前诊断性计算机断层扫描研究，由 2 名对患者数据不知情的放射科医生独立进行评估。所有计算机断层扫描图像均按侧（60 个）进行分析。评估了短轴直径为 8 毫米或更大的区域淋巴结和/或中央淋巴结坏死的几个影像学标准。如果组织病理学显示 3 个或更多的腹股沟淋巴结转移、和/或淋巴结外侵犯、和/或骨盆淋巴结受累，则该侧被认为是高危侧。
38 个侧（63%）的淋巴结有组织病理学累及，其中 22 个侧（37%）被定义为高危侧。术前计算机断层扫描上区域性淋巴结的中央淋巴结坏死和/或不规则淋巴结边界的存在，确定了高危亚组，其敏感性为 95%（21/22），特异性为 82%（31/38）。所有 7 个被错误地归类为高危的侧都有腹股沟转移，但它们被归类为低危侧。每个影像学参数的观察者间一致性几乎是完美的。
术前计算机断层扫描图像上中央淋巴结坏死和/或区域性淋巴结不规则边界的存在是识别高危病理性淋巴结阳性阴茎癌的准确且可重复的标准。这些标准可用于风险分层和患者咨询。
