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Abstract：
BACKGROUND: Lymph node metastasis is the main determinant of survival in penile cancer patients. Conventionally clinical palpability is used to stratify patients to Inguinal Lymph node dissection (ILND) if clinically node positive (cN +) or Dynamic sentinel node biopsy (DSNB) if clinically node negative (cN0). Studies suggest a false negative rate (FNR) of around 10% (5-13%) for DSNB. To our knowledge there are no studies reporting harder end point of survival and outcomes of all clinically node positive (cN +) patients. We present our outcome data of all patients with penile cancer including false negative rates and survival in both DSNB and ILND groups.
METHODS: One hundred fifty-eight consecutive patients (316 inguinal basins), who had lymph node surgery for penile cancer in a tertiary referral centre from Jan 2008 to 2018, were included in the study. All patients underwent ultrasound (US) ± fine needle aspiration cytology (FNAC) and then MRI/ CT, if needed, to stage their disease. We used combined clinical and radiological criteria (node size, architecture loss, irregular margins) to stratify patients to DSNB vs ILND as opposed to clinical palpability alone.
RESULTS: 11.2% i.e., 27/241 inguinal basins had lymph node positive disease by DSNB. 54.9% i.e., 39/71 inguinal basins (IBs) had lymph node-positive disease by ILND. 4 inguinal basins with no tracer uptake in sentinel node scans are being monitored at patient\'s request and have not had any recurrences to date. With a mean follow-up of 65 months (range 24-150), the false-negative rate (FNR) for DSNB is 0%. Judicious uses of cross-sectional imaging necessitated ILND in 2 inguinal basins with non-palpable nodes and negative US with false positive rate of 6.3% (2/32) for ILND. The same cohort of DSNB patients might have had 11.1% (3/27) FNR if only palpability criteria was used. 43 (28%) patients who did require cross sectional imaging as per our criteria had a low node positive rate of 4.7% (p = 0.03). Mean cancer specific survival of all node-positive patients was 105 months.
CONCLUSIONS: The performance of DSNB improved with enhanced radiological stratification of patients to either DSNB or ILND. We for the first time report the comprehensive outcome of all lymph node staging procedures in penile cancer.
METHODS: One hundred fifty-eight consecutive patients (316 inguinal basins), who had lymph node surgery for penile cancer in a tertiary referral centre from Jan 2008 to 2018, were included in the study. All patients underwent ultrasound (US) ± fine needle aspiration cytology (FNAC) and then MRI/ CT, if needed, to stage their disease. We used combined clinical and radiological criteria (node size, architecture loss, irregular margins) to stratify patients to DSNB vs ILND as opposed to clinical palpability alone.
RESULTS: 11.2% i.e., 27/241 inguinal basins had lymph node positive disease by DSNB. 54.9% i.e., 39/71 inguinal basins (IBs) had lymph node-positive disease by ILND. 4 inguinal basins with no tracer uptake in sentinel node scans are being monitored at patient\'s request and have not had any recurrences to date. With a mean follow-up of 65 months (range 24-150), the false-negative rate (FNR) for DSNB is 0%. Judicious uses of cross-sectional imaging necessitated ILND in 2 inguinal basins with non-palpable nodes and negative US with false positive rate of 6.3% (2/32) for ILND. The same cohort of DSNB patients might have had 11.1% (3/27) FNR if only palpability criteria was used. 43 (28%) patients who did require cross sectional imaging as per our criteria had a low node positive rate of 4.7% (p = 0.03). Mean cancer specific survival of all node-positive patients was 105 months.
CONCLUSIONS: The performance of DSNB improved with enhanced radiological stratification of patients to either DSNB or ILND. We for the first time report the comprehensive outcome of all lymph node staging procedures in penile cancer.
摘要：
背景：淋巴结转移是阴茎癌患者生存的主要决定因素。常规临床可触及性用于将患者分层为腹股沟淋巴结清扫术(ILND)(如果临床淋巴结阳性(cN+))或动态前哨淋巴结活检(DSNB)(如果临床淋巴结阴性(cN0))。研究表明，DSNB的假阴性率（FNR）约为10％（5-13％）。据我们所知，没有研究报告所有临床淋巴结阳性(cN+)患者的生存和结果更困难的终点。我们提供了所有阴茎癌患者的结果数据，包括DSNB和ILND组的假阴性率和生存率。
方法：一百五十八个连续患者（316个腹股沟盆），2008年1月至2018年在三级转诊中心接受阴茎癌淋巴结手术的患者被纳入研究.所有患者均行超声(US)±细针穿刺细胞学检查(FNAC),然后行MRI/CT检查,如果需要,阶段他们的疾病。我们使用了临床和放射学综合标准(淋巴结大小，建筑损失，不规则边缘）对患者进行DSNB和ILND的分层，而不是单独的临床可触性。
结果：11.2%，即27/241例腹股沟盆通过DSNB发现淋巴结阳性疾病。54.9%，即39/71腹股沟盆（IBs）由ILND引起淋巴结阳性疾病。根据患者的要求，正在监测4个在前哨淋巴结扫描中没有示踪剂摄取的腹股沟盆地，迄今为止没有任何复发。平均随访65个月（范围24-150），DSNB的假阴性率(FNR)为0%。正确使用横截面成像需要在2个腹股沟盆地中进行ILND，这些腹股沟盆地具有不可触及的淋巴结和阴性US，ILND的假阳性率为6.3％（2/32）。如果仅使用可触知标准,则相同的DSNB患者队列可能具有11.1%(3/27)的FNR。根据我们的标准，需要进行横断面成像的43例（28％）患者的淋巴结阳性率低，为4.7％（p=0.03）。所有淋巴结阳性患者的平均癌症特异性生存期为105个月。
结论：随着DSNB或ILND患者的放射分层增强，DSNB的表现得到改善。我们首次报告了阴茎癌所有淋巴结分期程序的综合结果。
方法：一百五十八个连续患者（316个腹股沟盆），2008年1月至2018年在三级转诊中心接受阴茎癌淋巴结手术的患者被纳入研究.所有患者均行超声(US)±细针穿刺细胞学检查(FNAC),然后行MRI/CT检查,如果需要,阶段他们的疾病。我们使用了临床和放射学综合标准(淋巴结大小，建筑损失，不规则边缘）对患者进行DSNB和ILND的分层，而不是单独的临床可触性。
结果：11.2%，即27/241例腹股沟盆通过DSNB发现淋巴结阳性疾病。54.9%，即39/71腹股沟盆（IBs）由ILND引起淋巴结阳性疾病。根据患者的要求，正在监测4个在前哨淋巴结扫描中没有示踪剂摄取的腹股沟盆地，迄今为止没有任何复发。平均随访65个月（范围24-150），DSNB的假阴性率(FNR)为0%。正确使用横截面成像需要在2个腹股沟盆地中进行ILND，这些腹股沟盆地具有不可触及的淋巴结和阴性US，ILND的假阳性率为6.3％（2/32）。如果仅使用可触知标准,则相同的DSNB患者队列可能具有11.1%(3/27)的FNR。根据我们的标准，需要进行横断面成像的43例（28％）患者的淋巴结阳性率低，为4.7％（p=0.03）。所有淋巴结阳性患者的平均癌症特异性生存期为105个月。
结论：随着DSNB或ILND患者的放射分层增强，DSNB的表现得到改善。我们首次报告了阴茎癌所有淋巴结分期程序的综合结果。
