Sentinel lymph node biopsy suitable for staging penile carcinoma
(25 May 2009: VIDYYA MEDICAL NEWS SERVICE) -- A new study led by the Netherlands Cancer Institute (NKI) and published online May 4 in the Journal of Clinical Oncology confirms that sentinel lymph node biopsy (SLNB) is a valid staging option for men with early stage penile cancer.
Removal of the lymph nodes in the groin (called inguinal lymph node dissection) is often performed in patients who have early stage penile carcinoma and no obvious lymph node metastases to prevent the possible growth of undiscovered metastases. However, this procedure can cause significant long-term side effects and may be unnecessary in 75 to 80 percent of these patients.
Researchers from two institutions performed SLNB on 323 patients using a modified procedure involving ultrasound imaging and other improvements to reduce the rate of false-negative results seen in earlier studies. Lymphatic mapping after surgery to remove the primary tumor was performed 596 times (including both sides of the body in most patients). Seventy-nine groins contained a sentinel lymph node positive for tumor cells; these patients underwent immediate inguinal lymph node dissection. Patients with a negative SLNB did not have further surgery.
After a median follow-up period of 17.9 months, the overall false-negative rate was 7 percent: 6 patients with negative SLNB had an inguinal recurrence of their cancer. The researchers pointed out that no learning curve was seen when the modified procedure was introduced from the first institution to the second; the earlier procedures performed at the second institution were not more likely to produce false-negative results.
Although the authors caution that a longer follow-up time may reveal more false-negative results, they conclude that “with the use of an up-to-date protocol, sentinel node biopsy for penile carcinoma is a suitable procedure to identify patients with clinically node-negative disease who have occult metastasis…The risk of a false-negative procedure should be weighed against the morbidity of an elective inguinal lymph node dissection.”
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