Lymphatic mapping and biopsy of the sentry ganglion in cancer of the penis (penile cancer). A feasibility study and preliminary report

Narciso Hernández-Toris; Joel Quintero-Becerra; José Francisco Gallegos-Hernández; Ramiro Flores-Ojeda; Isabel Alvarado-Cabrero; Donaciano Flores-López; Pablo Pichardo-Romero

2007, Number 2

Cir Cir 2007; 75 (2)

Lymphatic mapping and biopsy of the sentry ganglion in cancer of the penis (penile cancer). A feasibility study and preliminary report

Hernández-Toris N, Quintero-Becerra J, Gallegos-Hernández JF, Flores-Ojeda R, Alvarado-Cabrero I, Flores-López D, Pichardo-Romero P

Full text

How to cite this article

Language: Spanish
References: 27
Page: 87-91
PDF size: 82.67 Kb.

ABSTRACT

Most patients with invasive squamous cell carcinoma of the penis do not have inguinal node metastasis at the time of diagnosis and 50% of those having palpable nodes are inflammatory. Penis cancer (PC) treatment implies resection of the primary tumor and inguinal lymphadenectomy; nevertheless, morbidity related to this procedure is high and its usefulness may be questioned in patients without metastasis in dissected nodes. Lymphatic mapping with sentinel node biopsy (LMSNB) is a valid alternative, useful in other neoplasias. The objective of this study is to determine if it is possible to identify a sentinel node (SN) in patients with PC. Patients with T1-2 PC without palpable nodes (N0) were included. LMSNB was carried out with the combined technique (blue dye and radiocolloid). All patients underwent an elective bilateral inguinal lymphadenectomy. Sensitivity and false negative index were calculated. SNs were sent for transoperative study with imprint technique and, definitively, with serial cuts and hematoxylin/eosin staining. Nine patients showed results with 32 lymph carrier zones and SN was identified in all of them, 4 regions had metastasis, in 3 the SN was metastatic and in one patient was metastasis-negative (false negative); sensitivity = 80%; false negatives index = 20%. Seven patients (77%) did not have node metastasis. LMSNB is an alternative for staging PC patients and could prevent unnecessary inguinal lymphadenectomies. A larger number of patients is required to validate the study. The combined technique offers a high rate of success in SN identification.

REFERENCES

Herr HW, Salbagni G, Bajorin DF, et al. Cancer of the urethra and penis. In: De Vita VT Jr, Hellman S, Rosenberg SA, eds. Cancer Principles and Practice of Oncology, 6th ed. Philadelphia: Lippincott Williams & Wilkins;2001. pp. 1484-1489.
2. Riveros M, Lebrone RF. Geographical pathology of cancer of the penis. Cancer 1963;16:798.
3. Secretaría de Salud. Registro histopatológico de neoplasias malignas: compendio, mortalidad, morbilidad. México: SSA; 1999.
4. Rodríguez CSA, Labastida AS, Tapia CR, et al. Registro histopatológico de neoplasias en México en población derechohabiente del IMSS 1993-1996. México: SSA; 2000.
5. Kochen M, McCurdy S. Circumcision and the risk of cancer of the penis. A life-table analysis. Am J Dis Child 1980;134:484-486.
6. Daling JR, Madeleine MM, Johnson LG, et al. Penile cancer: importance of circumcision, papillomavirus and smoking in in situ and invasive disease. Int J Cancer 2005;1164:606-616.
7. Micali G, Nasca MR, Innocenzi D, et al. Invasive penile carcinoma: a review. Dermatol Surg 2004;30:311-320.
8. Horenblas S. Lymphadenectomy for squamous cell carcinoma of the penis. Part 1: diagnosis of lymph node metastasis. BJU Int 2001;88:467-472.
9. Ficarra V, Zattoni F, Cunico SC, et al. Gruppo Uro-Oncologico del Nord Est (Northeast Uro-Oncological Group) Penile Cancer data base data. Lymphatic and vascular embolizations are independent predictive variables of inguinal lymph node involvement in patients with squamous cell carcinoma of the penis. Cancer 2005;103:2507-2516.
10. Cabañas RM. An approach for the treatment of penile carcinoma. Cancer 1977;39:456-466.
11. Catalona WJ. Role of lymphadenectomy in carcinoma of the penis. Urol Clin North Am 1980;7:785-792.
12. Perineti E, Crane DB, Catalona WJ. Unreliability of sentinel node biopsy for staging penile carcinoma. J Urol 1980;124:734-735.
13. Wong JH, Cagle LA, Morton DL. Lymphatic drainage of skin to a sentinel node in feline model. Ann Surg 1991;214:637-641.
14. Morton DL, Wen DR, Wong JH, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg 1992;127:392-399.
15. Gallegos HJF. ¿Qué es el ganglio centinela? Acta Med 2005;3:91-98.
16. Gallegos HJF, Gutiérrez CF, Barroso BS, et al. Identificación del ganglio centinela con azul patente V en pacientes con melanoma cutáneo. Gac Med Mex 1998;134:285-288.
17. Kroon BJ, Horenblas S, Meinhardt W, et al. Dynamic sentinel node biopsy in penile carcinoma: evolution of 10 years experience. Eur Urol 2005;47:601-606.
18. Isawa J, Kedar D, Wong F, et al. Sentinel lymph node biopsy in penile cancer: evolution and insights. Can J Urol 2005;12(suppl 1):24-29.
19. AJCC. Cancer Staging Manual, 6th ed. New York: Springer;2002.
20. Gallegos HJF, Chávez GMA. Utilidad del mapeo linfático con inyección subareolar de colorante azul patente V en la etapificación del cáncer de mama. Rev Invest Clin 2003;55:407-411.
21. Gallegos HJF, Melhado OA. Cómo efectuar el mapeo linfático en cáncer de mama. Técnica, indicaciones y controversias. Cir Ciruj 2002;7:86-92.
22. Arana LI, Neyra AG, Muñoz RJA, et al. Cáncer del pene: experiencia en el tratamiento de 52 pacientes. Bol Col Mex Urol 1994;11:91-96.
23. Ekstrom T, Edsmyr F. Cancer of the penis: a clinical study of 292 cases. Acta Chir Scand 1958;155:25-45.
24. Beggs JH, Spratt JS. Epidermoid carcinoma of the penis. J Urol 1964;91:166-172.
25. McDougal WS, Kirchner FK, Edwards RH, et al. Treatment of carcinoma of the penis: the case of primary lymphadenectomy. J Urol 1986;136:38-41.
26. Ornellas AA, Seixas AL, Marota, et al. Surgical treatment of invasive squamous cell carcinoma of the penis: retrospective analysis of 350 cases. J Urol 1994;151:1244-1247.
27. Tanis PJ, Lont AP, Meinhardt W, et al. Dynamic sentinel node biopsy for penile cancer: reliability of a staging technique. J Urol 2002;168:76-80.