Department of Urology, Aarhus University Hospital, Aarhus, Denmark.
Department of Pathology, Aarhus University Hospital, Aarhus, Denmark.
Scand J Urol. 2021 Oct;55(5):383-387. doi: 10.1080/21681805.2021.1882560. Epub 2021 Feb 11.
Anatomy of the lymphatic drainage guides the extent of inguinal lymph node dissection in penile cancer.
To prospectively assess the lymphatic drainage of penile cancer with single-photon emission computed tomography CT (SPECT-CT) and implications for the extent of inguinal lymph node dissection.
We assessed the lymphatic drainage of 62 patients with at least unilateral clinical lymph node-negative (cN0) status with SPECT-CT at our tertiary referral centre. We evaluated 122 cN0 inguinal basins and compared them to the histopathological outcome. The inguinal regions were divided into ten different Daseler zones on SPECT-CT. The surgical team filled in a corresponding scheme at sentinel node biopsy and sent lymph nodes from each Daseler zone individually for histopathological examination.
SPECT-CT successfully visualized lymphatic drainage in 116 of the 122 cN0 inguinal basins (95.1%). The vast majority of sentinel nodes and all metastatic nodes were located in central and superior inguinal zones, including six metastatic nodes in lateral superior zones. Minimal lymphatic drainage was seen to the inferior Daseler zones and no metastatic deposits were located here. No direct pelvic drainage was observed.
Penile cancer lymphatic drainage is primarily to sentinel in the superior and central zones of Daseler. Colleagues practicing a modified inguinal lymph node dissection as a standard in cN0 patients are encouraged to include all these zones, while the inferior zones can be omitted. This study confirms the absence of lymphatic drainage directly to the pelvic region and supports the practice of omitting pelvic nodes from sentinel node biopsy.
淋巴引流解剖学指导阴茎癌腹股沟淋巴结清扫的范围。
前瞻性评估单光子发射计算机断层扫描 CT（SPECT-CT）在阴茎癌中的淋巴引流及其对腹股沟淋巴结清扫范围的影响。
我们在我们的三级转诊中心评估了 62 例至少单侧临床淋巴结阴性（cN0）状态的患者的淋巴引流情况。我们评估了 122 个 cN0 腹股沟淋巴结窝，并将其与组织病理学结果进行比较。在 SPECT-CT 上，将腹股沟区域分为 10 个不同的 Daseler 区。手术团队在进行前哨淋巴结活检时填写了相应的方案，并将每个 Daseler 区的淋巴结单独送病理检查。
SPECT-CT 成功地可视化了 122 个 cN0 腹股沟淋巴结窝中的 116 个（95.1%）。绝大多数前哨淋巴结和所有转移性淋巴结均位于腹股沟的中央和上部区域，包括 6 个位于外侧上部区域的转移性淋巴结。Daseler 下部区域的淋巴引流很少见，且没有转移性沉积物。没有观察到直接向骨盆区域的引流。
阴茎癌的淋巴引流主要是前哨淋巴结位于 Daseler 的上部和中央区域。鼓励那些在 cN0 患者中常规行改良腹股沟淋巴结清扫术的同事包括所有这些区域，而可以省略下部区域。本研究证实了直接向骨盆区域的淋巴引流不存在，并支持省略前哨淋巴结活检中骨盆淋巴结的做法。
