Senthil Kumar M P, Ananthakrishnan N, Prema V
Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
Br J Urol. 1998 Mar;81(3):453-7. doi: 10.1046/j.1464-410x.1998.00562.x.
To evaluate the accuracy of clinical examination and fine-needle aspiration cytology (FNAC) in detecting groin metastases in patients with carcinoma of the penis, and to assess the positive and negative predictive value (PPV, NPV) of a preliminary sentinel lymph-node biopsy (SNB) and biopsy of the most medial of the horizontal group of inguinal lymph nodes (MIN) in selecting patients for an ilio-inguinal block dissection.
The study comprised 28 patients (56 groins) with Stage I (one), Stage II (11) and Stage III (16) carcinoma of the penis. All patients underwent a detailed clinical examination followed by FNAC of the palpable inguinal nodes, and were subsequently submitted for block dissection. The MIN, the SN and the rest of the inguinal and iliac nodes were histologically examined separately for metastases.
The clinical evaluation had a sensitivity of 74%, a specificity of 61%, a PPV of 57% and a NPV of 77%. The corresponding values for FNAC were all 100%, and the specificity and PPV for both MIN and SN were 100%. The sensitivity and NPV of MIN were higher than for SN, although not significantly so.
Clinical examination alone is inaccurate in selecting patients with carcinoma of the penis for block dissection. FNAC is accurate and specific when nodes are palpable; in those with impalpable nodes a preliminary MIN biopsy followed by SNB if the MIN biopsy is negative will accurately select all patients with metastases in the groin nodes. This can be performed by examining frozen sections of the lymph nodes; if positive, block dissection can be carried out at the same time.
评估临床检查及细针穿刺细胞学检查（FNAC）在检测阴茎癌患者腹股沟转移方面的准确性，并评估初步前哨淋巴结活检（SNB）及腹股沟淋巴结水平组最内侧淋巴结活检（MIN）在选择进行髂腹股沟淋巴结清扫术患者时的阳性和阴性预测值（PPV、NPV）。
本研究纳入28例阴茎癌患者（56个腹股沟），其中I期（1例）、II期（11例）和III期（16例）。所有患者均接受详细的临床检查，随后对可触及的腹股沟淋巴结进行FNAC检查，之后接受淋巴结清扫术。分别对MIN、SN以及其余腹股沟和髂淋巴结进行组织学检查以确定有无转移。
临床评估的敏感性为74%，特异性为61%，PPV为57%，NPV为77%。FNAC的相应数值均为100%，MIN和SN的特异性及PPV均为100%。MIN的敏感性和NPV高于SN，尽管差异无统计学意义。
仅靠临床检查在选择阴茎癌患者进行淋巴结清扫术时不准确。当淋巴结可触及，FNAC准确且具有特异性；对于不可触及淋巴结的患者，先行MIN活检，若MIN活检为阴性则行SNB，可准确筛选出所有腹股沟淋巴结有转移的患者。这可通过检查淋巴结冰冻切片来进行；若为阳性，可同时进行淋巴结清扫术。
