To assess the accuracy of dynamic sentinel lymph node biopsy (DSNB) after negative ultrasonography (US) guided fine needle aspiration (FNA) for ILN staging.
We performed a retrospective analysis of men with ≥T1G2 penile cancer and negative inguinal US guided FNA undergoing DSNB. Men with suspicious US but negative FNA underwent US guided ILN excision. Men with ≥T1G2 local recurrence during follow-up and non-squamous cell histologies were excluded. Descriptive analysis was performed, and sensitivity and negative predictive values (NPV) were calculated.
We included 403 men with 728 groins with negative FNA undergoing DSNB +/- US guided lymph node excision. At least one sentinel node (SN) was visualised in 93% during the 1st and in 7% during the 2nd lymphoscintigraphy. Median SNs visualised preoperatively was 1 and a median of 2 nodes were resected. ILN metastases were detected in 9% groins in men with non-palpable and in 17% men with palpable lymph nodes. Stratified by non-palpable and palpable ILN, non-local recurrence despite pathologically negative DSNBs was observed in 0.5% and 0%. Limited to men with at least 24 months follow-up, non-local recurrence after negative DSNBs was observed in 0.4% and 0%. The sensitivity of DSNB was 96% and NPV was 100%. The main limitation of this analysis is its retrospective nature with inherit biases.
Inguinal US and FNA followed by DSNB can accurately stage men with both non-palpable and palpable ILN which provides logistical and surgical advantages.
BJU international. 2022 Jan 29 [Epub ahead of print]
Esther W C Lee, Allaudin Issa, Pedro Oliveira, Maurice Lau, Vijay Sangar, Arie Parnham, Christian D Fankhauser
The Christie NHS Foundation Trusts, Manchester, UK.