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Yoganarasimha J, Sharma RM, Giridhar A, Rao VB, KVVN R, Rao ST. Role of Sentinel Lymph Node Biopsy in Clinically Node Negative Carcinoma Penis - a Prospective Study. Indian J Surg Oncol 2023; 14:288-291. [PMID: 37324298 PMCID: PMC10267064 DOI: 10.1007/s13193-022-01656-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 09/19/2022] [Indexed: 11/07/2022] Open
Abstract
Nodal metastasis is a strong prognostic indicator in carcinoma penis, with 25% difference in 5-year cancer-specific survival among node negative and node positive patients. This study aims to assess efficacy of SLNB in identifying occult nodal metastasis (seen in 20-25% of cases), thus avoiding morbidity of prophylactic groin dissection in rest. Study was conducted between June 2016 and December 2019 on 42 patients (84 groins). Primary outcomes assessed were sensitivity, specificity, false negative rates, positive predictive value, and negative predictive value of sentinel lymph node biopsy (SLNB) compared to superficial inguinal node dissection (SIND). Secondary outcomes were to know prevalence of nodal metastasis, sensitivity, specificity, false negative rates, positive predictive value (PPV), negative predictive value (NPV) of frozen section study, and ultrasonography (USG) compared to histopathological examination (HPE) and to evaluate false negative results of fine needle aspiration cytology (FNAC). Patients with impalpable inguinal nodes were subjected to USG and FNAC of suspicious nodes. Only those with non-suspicious USG/negative FNAC were included. Patients who were node positive, had prior chemotherapy/radiotherapy/prior groin surgery, or medically unfit for surgery were excluded. Dual-dye technique was used to identify sentinel node. Superficial inguinal dissection was done in all cases and both specimens were subject to frozen section. If ≥ 2 nodes were involved on frozen section, ilioinguinal dissection was done. SLNB had sensitivity, specificity, PPV, NPV, and accuracy of 100%, respectively. There were no false negative results of frozen section study among 168 specimens. Ultrasonography had sensitivity of 50%, specificity of 48.75%, PPV of 4.65%, NPV of 95.12%, and accuracy of 48.81%. We had 2 false negative results of FNAC. Sentinel node biopsy with frozen section study when done in properly selected cases using dual-dye technique in high volume centers by experienced professionals is a very reliable tool in establishing the nodal status, thereby facilitating need directed treatment, thus prevent either over/under treatment.
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Affiliation(s)
- Jayakarthik Yoganarasimha
- Division of Uro-Oncology, Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Road Number 10, Banjara Hills, Hyderabad, Telangana India 500034
| | - Rakesh Manilal Sharma
- Division of Uro-Oncology, Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Road Number 10, Banjara Hills, Hyderabad, Telangana India 500034
| | - Ashwin Giridhar
- Division of Uro-Oncology, Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Road Number 10, Banjara Hills, Hyderabad, Telangana India 500034
| | - Vishal B. Rao
- Department of Pathology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, India
| | - Raju KVVN
- Division of Uro-Oncology, Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Road Number 10, Banjara Hills, Hyderabad, Telangana India 500034
| | - Subramanyeshwar T. Rao
- Division of Uro-Oncology, Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Road Number 10, Banjara Hills, Hyderabad, Telangana India 500034
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Zhang W, Ni T, Tang W, Yang G. The Role of Contrast-Enhanced Ultrasound in the Differential Diagnosis of Tuberous Vas Deferens Tuberculosis and Metastatic Inguinal Lymph Nodes. Diagnostics (Basel) 2023; 13:diagnostics13101762. [PMID: 37238246 DOI: 10.3390/diagnostics13101762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 04/30/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
PURPOSE To retrospective analysis and summary the features of tuberous vas deferens tuberculosis (VD TB) and inguinal metastatic lymph nodes (MLN) in routine ultrasound (US) and contrast-enhanced US (CEUS) as well as to assess the utility of CEUS in differentiating between the two diseases. METHODS The US and CEUS findings of patients with pathologically confirmed tuberous VD TB (n = 17) and inguinal MLN (n = 28), including the number of lesions, presence of bilateral disease, differences in internal echogenicity, a conglomeration of lesions, and blood flow within the lesions, were retrospectively analyzed. RESULTS Routine US showed no significant difference in the number of lesions, nodule size, internal echogenicity, sinus tract, or skin rupture; however, significant differences were observed between the two conditions in the conglomeration of lesions (χ2 = 6.455; p = 0.023) and the degree, intensity, and echogenicity pattern on CEUS (χ2 = 18.865, 17.455, and 15.074, respectively; p = 0.000 for all). CONCLUSIONS CEUS can show the blood supply of the lesion, and judge the physical condition of the lesion better than US. Homogeneous, centripetal, and diffuse enhancement should prompt a diagnosis of inguinal MLN, whereas lesions with heterogeneous and diffuse enhancement on CEUS should be considered as VD TB. CEUS has great diagnostic value in differentiating between tuberous VD TB and inguinal MLN.
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Affiliation(s)
- Wenzhi Zhang
- Department of Ultrasonography, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine (Hangzhou Red Cross Hospital), Hangzhou 310003, China
| | - Tu Ni
- Department of Ultrasonography, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine (Hangzhou Red Cross Hospital), Hangzhou 310003, China
| | - Wei Tang
- Department of Ultrasonography, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine (Hangzhou Red Cross Hospital), Hangzhou 310003, China
| | - Gaoyi Yang
- Department of Ultrasonography, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine (Hangzhou Red Cross Hospital), Hangzhou 310003, China
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Lützen U, Zuhayra M, Marx M, Zhao Y, Colberg C, Knüpfer S, Baumann R, Kähler KC, Jünemann KP, Naumann CM. Value and efficiency of sentinel lymph node diagnostics in patients with penile carcinoma with palpable inguinal lymph nodes as a new multimodal, minimally invasive approach. Eur J Nucl Med Mol Imaging 2016; 43:2313-2323. [PMID: 27519598 DOI: 10.1007/s00259-016-3482-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 07/31/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE The international guidelines recommend sentinel lymph node biopsy (SLNB) for lymph node staging in penile cancer with non-palpable inguinal lymph nodes (LN) but it is not recommended with palpable inguinal LN. The aim of this study was to evaluate the reliability and morbidity of SLNB in combination with an ultrasound-guided resection of suspect inguinal LNs as a new multimodal, minimally invasive staging approach in these patients. METHODS We performed SLNB in 26 penile cancer patients with 42 palpable inguinal LNs. Prior to the combined staging procedures the patients underwent an ultrasound examination of the groins as well as planar lymphatic drainage scintigraphy and SPECT/CT scans. During the surgical procedure, the radioactive-labelled sentinel lymph nodes and, in addition, sonographically suspect LNs, were resected under ultrasound guidance. Follow-up screening was done by ultrasound examination of the groins according to the guidelines of the European Association of Urology. RESULTS Nineteen groins of 42 preoperatively palpable inguinal findings were histologically tumor-positive. SLNB alone showed lymphogenic metastases in 14 groins. Sonography revealed five further metastatic groins, which would not have been detected during SLNB due to a tumor-related blockage of lymphatic drainage or a so-called re-routing of the tracer. During follow-up, none of the 28 groins with tumor-negative LN status showed any LN recurrence in this combined investigation technique. The median follow-up period was 46 (24 to 92) months. Morbidity of this procedure was low at 4.76 % in relation to the number of groins resp. 7.69 % in relation to the number of patients. CONCLUSIONS The results show that this combined procedure is a reliable multimodal diagnostic approach for treatment of penile cancer patients with palpable inguinal LNs. It is associated with low morbidity rates. SLNB alone would lead to a significantly higher false-negative rate in these patients. The encouraging results of this work can extend the range of indications for nuclear medicine in the form of SLNB using radioactive tracers in this patient group.
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Affiliation(s)
- Ulf Lützen
- Department of Nuclear Medicine, Molecular Imaging Diagnostics and Therapy, University Hospital Schleswig Holstein, Campus Kiel, Feldstr. 21 (Haus 50), D-24105, Kiel, Germany.
| | - Maaz Zuhayra
- Department of Nuclear Medicine, Molecular Imaging Diagnostics and Therapy, University Hospital Schleswig Holstein, Campus Kiel, Feldstr. 21 (Haus 50), D-24105, Kiel, Germany
| | - Marlies Marx
- Department of Nuclear Medicine, Molecular Imaging Diagnostics and Therapy, University Hospital Schleswig Holstein, Campus Kiel, Feldstr. 21 (Haus 50), D-24105, Kiel, Germany
| | - Yi Zhao
- Department of Nuclear Medicine, Molecular Imaging Diagnostics and Therapy, University Hospital Schleswig Holstein, Campus Kiel, Feldstr. 21 (Haus 50), D-24105, Kiel, Germany
| | - Christian Colberg
- Department of Urology and Pediatric Urology, University Hospital Schleswig Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 18, D-24105, Kiel, Germany
| | - Stephanie Knüpfer
- Department of Urology and Pediatric Urology, University Hospital Schleswig Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 18, D-24105, Kiel, Germany
| | - René Baumann
- Department of Radio Oncology, University Hospital Schleswig Holstein, Campus Kiel, Feldstr. 21 (Haus 50), D-24105, Kiel, Germany
| | - Katharina Charlotte Kähler
- Department of Dermatology, Venerology and Allergology, University Hospital Schleswig Holstein, Campus Kiel, Schittenhelmstr. 7, D-24105, Kiel, Germany
| | - Klaus-Peter Jünemann
- Department of Urology and Pediatric Urology, University Hospital Schleswig Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 18, D-24105, Kiel, Germany
| | - Carsten Maik Naumann
- Department of Urology and Pediatric Urology, University Hospital Schleswig Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 18, D-24105, Kiel, Germany
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