Predicting regional lymph node metastasis in carcinoma of the penis: a comparison between fine‐needle aspiration cytology, sentinel lymph node biopsy and medial inguinal lymph node biopsy

Abstract

Objective To evaluate the accuracy of clinical examination and fine‐needle aspiration cytology (FNAC) in detecting groin metastases in patients with carcinoma of the penis, and to assess the positive and negative predictive value (PPV, NPV) of a preliminary sentinel lymph‐node biopsy (SNB) and biopsy of the most medial of the horizontal group of inguinal lymph nodes (MIN) in selecting patients for an ilio‐inguinal block dissection. Patients and methods The study comprised 28 patients (56 groins) with Stage I (one), Stage II (11) and Stage III (16) carcinoma of the penis. All patients underwent a detailed clinical examination followed by FNAC of the palpable inguinal nodes, and were subsequently submitted for block dissection. The MIN, the SN and the rest of the inguinal and iliac nodes were histologically examined separately for metastases. Results The clinical evaluation had a sensitivity of 74%, a specificity of 61%, a PPV of 57% and a NPV of 77%. The corresponding values for FNAC were all 100%, and the specificity and PPV for both MIN and SN were 100%. The sensitivity and NPV of MIN were higher than for SN, although not significantly so. Conclusion Clinical examination alone is inaccurate in selecting patients with carcinoma of the penis for block dissection. FNAC is accurate and specific when nodes are palpable; in those with impalpable nodes a preliminary MIN biopsy followed by SNB if the MIN biopsy is negative will accurately select all patients with metastases in the groin nodes. This can be performed by examining frozen sections of the lymph nodes; if positive, block dissection can be carried out at the same time.

Fine‐needle aspiration cytology predicts inguinal lymph node metastasis without antibiotic pretreatment in penile carcinoma

“…False‐positive results for metastatic lymphadenopathy in primary penile cancer have rarely been reported using FNA cytology [8,10,28], but there was one case in the present series. Although some centres, including ours, have advocated routine inguinal dissection where there is palpable lymphadenopathy, this policy results in some cases where metastatic disease is not identified.…”

“…It is well recognised that clinical examination of groin nodes for metastases is inaccurate [10], as in the present study, yet the reported incidence of inguinal LN metastases in penile cancer is 40–50%[4]. The inguinal nodes are the initial drainage point for the lymphatics of the penis, and it is generally accepted that all men with primary SCC of the penis where such nodal metastases are present should be treated by inguinal LND [11].…”

“…Senthil Kumar et al. [10] reported complete sensitivity of FNA cytology for detecting metastatic penile cancer in palpable inguinal lymphadenopathy in a series of 28 patients. The FNA cytology was assessed at the time of inguinal LND and not before antibiotic therapy.…”

“…Despite the sensitivity, they suggested that men with negative FNA cytology should have medial inguinal LN biopsy to overcome the risk of a false‐negative cytological assessment. Accurate sampling by FNA is often cited as an issue when many nodes are enlarged, as is often the case [10]. This has led to other methods of accurately identifying nodes for cytological assessment using lymphangiography and CT, which have been largely discouraging [7,25–27].…”

New fields of application of the sentinel lymph node biopsy in the pathologic staging of solid neoplasms: Review of literature and surgical perspectives

“…Ravi et al [28] performed an ''inguinal pick procedure'' in 52 patients, which included biopsy of all suspicious nodes and removal of nodes in the ''sentinel node area'': 5 of 52 patients (9.6%) had nodal metastasis; notably, 7 of 47 patients (15%) with negative histology developed inguinal lymph node recurrence. Senthil-Kumar et al [29] investigated 28 patients undergoing groin dissection; clinically nodenegative patients underwent dissection of the most medial lymph nodes of the inguinal region, and in 20 patients with node-negative disease the specificity and positive predictive values were 100%.…”