Lonergan P E, Nic An Riogh A, O'Kelly F, Lundon D J, O'Sullivan D, O'Connell M, Hegarty P K
Department of Urology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.
Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland.
Ir J Med Sci. 2017 Nov;186(4):841-845. doi: 10.1007/s11845-017-1558-3. Epub 2017 Jan 19.
The presence of nodal metastases is the single most important prognostic factor in penile cancer. However, reliable assessment of nodal status in clinically node-negative (cN0) patients poses a challenge. Approximately 20% of these patients harbour occult nodal metastases. Currently available non-invasive radiological investigations are unreliable in excluding micrometastatic disease.
Dynamic sentinel node biopsy (DSNB) is a minimally invasive procedure for assessing lymph node involvement. We report our initial experience with DSNB in assessing the status of regional lymph nodes in cN0 penile cancer patients.
DSNB was performed in penile cancer patients with at least one cN0 groin. All patients undergoing DSNB at our institution were included. Lymphoscintigraphic images were obtained from all patients, after intradermal, peritumoral injection of a Technetium-99m nanocolloid. The sentinel nodes were defined as the nodes identified on lymphoscintigraphy, which were also radioactive intraoperatively using a gamma probe.
In total, 18 groins from 11 patients underwent DSNB. Of these, 11 patients underwent bilateral DSNB and 4 had unilateral DSNB. The mean (range) age of patients at the time of presentation of their primary tumour was 63 (39-78) years. A mean of 1.2 nodes per groin was retrieved. One lymph node was positive in one patient, who subsequently underwent a bilateral inguinal lymph node dissection. Overall, the median (range) follow-up was 12.8 (2.7-31.3) months with no local or regional recurrences.
Further cases and longer follow-up will define the accuracy of this technique in the Irish population.
淋巴结转移的存在是阴茎癌最重要的单一预后因素。然而，对临床淋巴结阴性（cN0）患者的淋巴结状态进行可靠评估具有挑战性。这些患者中约20%存在隐匿性淋巴结转移。目前可用的非侵入性放射学检查在排除微转移疾病方面并不可靠。
动态前哨淋巴结活检（DSNB）是一种评估淋巴结受累情况的微创手术。我们报告了我们在评估cN0阴茎癌患者区域淋巴结状态方面使用DSNB的初步经验。
对至少有一个cN0腹股沟的阴茎癌患者进行DSNB。纳入在我们机构接受DSNB的所有患者。在皮内、肿瘤周围注射99m锝纳米胶体后，从所有患者获取淋巴闪烁造影图像。前哨淋巴结定义为淋巴闪烁造影中识别出的淋巴结，术中使用γ探针时这些淋巴结也具有放射性。
总共11例患者的18个腹股沟接受了DSNB。其中，11例患者接受了双侧DSNB，4例接受了单侧DSNB。原发性肿瘤出现时患者的平均（范围）年龄为63（39 - 78）岁。每个腹股沟平均取出1.2个淋巴结。1例患者的1个淋巴结呈阳性，该患者随后接受了双侧腹股沟淋巴结清扫术。总体而言，中位（范围）随访时间为12.8（2.7 - 31.3）个月，无局部或区域复发。
更多病例和更长时间的随访将确定该技术在爱尔兰人群中的准确性。
