Sentinel node procedure in low-stage/low-grade penile carcinomas.

OBJECTIVE: To optimize the indication for sentinel lymph node (SLN) biopsy according to tumour size in penile carcinoma.

MATERIAL AND METHODS: This was a retrospective analysis of 23 consecutive patients (median age 65 years; range 49-85 years) with primary penile carcinoma classified according to the TNM classification as stage T1-T3 who were identified as having SLNs in the groins. SLNs were detected by means of preoperative injection of a 99mTc nanocolloid around the tumour and peroperative use of a gamma detector probe. The average tumour size was 2.9+/-1.3 cm.

RESULTS: In 7/25 patients with penile carcinoma examined with the SLN method, metastases to inguinal lymph nodes could be demonstrated. Two out of three patients with primary penile carcinomas classified as T1 according to the TNM classification and tumours > 3 cm in diameter had inguinal lymph node metastases. One of the patients had a micrometastasis, which was detected by means of immunohistochemical analysis. Seven out of eight patients with penile carcinomas > 3 cm in diameter had lymph node metastases. We did not observe any major surgical complications associated with the SLN procedure.

CONCLUSION: These data indicate that penile carcinomas with a diameter of >3 cm should be investigated with SLN biopsy regardless of stage. However, multicentre studies are needed in order to obtain the appropriate number of patients.