Prevalence of High-Risk Prostate Cancer Metastasis to Cloquet’s Ilioinguinal Lymph Node

Abstract

Purpose: Cloquet's node, located at the junction between the deep inguinal nodes and the external iliac chain, is easily accessible and commonly excised during pelvic lymph node dissection for prostate cancer. However, we hypothesize that Cloquet's node is not part of lymphatic metastatic spread of prostate cancer. Materials and Methods: Between September 2016 and June 2019, 105 consecutive patients with high-risk prostate cancer (cT3a or Grade Group 4/5, or prostate specific antigen >20 ng/ml) underwent a laparoscopic radical prostatectomy and pelvic lymph node dissection. First, Cloquet's node was identified, retrieved and submitted separately to pathology as right and left Cloquet's node. Next, a pelvic lymph node dissection was completed including the external iliac, obturator fossa and hypogastric nodal packets. Each lymph node was cut into 3 mm slices which were separately embedded in paraffin, stained with hematoxylin and eosin, and examined microscopically. Results: The final analysis included 95 patients. In this high-risk population, the median number of nodes removed was 22 (IQR 18e29); 39/95 patients (41%) had lymph node metastasis. The median number of Cloquet's nodes removed was 2 (IQR 2e3). Cloquet's node was negative in all but 1 patient (1.1%), who had very high-risk features and high metastatic burden in the lymph nodes. Conclusions: In high-risk prostate cancer, metastasis to the ilioinguinal node of Cloquet is rare. Given this low prevalence, Cloquet's node can be safely excluded from the pelvic lymph node dissection template.

The Detection of Prostate Cancer with Magnetic Resonance Imaging-targeted Prostate Biopsies is Superior With the Transperineal vs the Transrectal Approach. A European Association of Urology-Young Academic Urologists Prostate Cancer Working Group Multi-institutional Study. Reply.

“…To the Editor: We thank Bryant et al, who emphasized the importance of prospective randomized controlled trials (RCTs) to validate the retrospective findings from our study. 1 The comparison of transrectal vs transperineal (TP) MRI-guided prostate biopsy in terms of accuracy and safety is one of the timely research topics in this area. However, there are several points that still need to be addressed in terms of safety and accuracy.…”

The Role of Contrast-Enhanced Ultrasound in the Differential Diagnosis of Tuberous Vas Deferens Tuberculosis and Metastatic Inguinal Lymph Nodes

“…Metastatic inguinal lymph nodes are diseases caused by metastasis of malignant tumors from the drainage area of inguinal lymph nodes to lymph nodes in the groin. Common malignant tumors are: primary malignant tumors of the genitalia, skin, rectum, or prostate [6,7]. Misdiagnosis of metastatic lymph nodes often leads to adverse consequences, so early and accurate diagnosis of metastatic lymph nodes is very important.…”

Prevalence of High-risk Prostate Cancer Metastasis to Cloquet’s Ilioinguinal Lymph Node. Letter.

“…To the Editor: We read with great interest the article by Plata Bello et al that evaluated the prevalence of metastasis to Cloquet’s node in 95 high-risk prostate cancer patients who underwent radical prostatectomy and pelvic lymph node dissection. 1 We commend the authors for this well-written paper covering a challenging topic. Little is known about the lymphatic dissemination of prostate cancer into Cloquet’s nodes.…”