Editorial comment on: Anatomical mapping of lymphatic drainage in penile carcinoma with SPECT-CT: implications for the extent of inguinal lymph node dissection.

Abstract

After optimizing the reliability and safety of dynamic sentinel node biopsy in cNO penile cancer patients, reducing false negative and complication rate to 4.8% and 5.7% respectively [1], the Netherlands Cancer Institute Penile Cancer Group studied the anatomical mapping of the lymphatic drainage of penile cancer in 50 consecutive patients (August 2006–August 2007!) who underwent SPECT-CT imaging immediately after dynamic and static imaging, 30 min and 2 h after injection of technetium-99m nanocolloid [2]. The inguinal regions were divided according to the five Daseler zones [3] and the nodes of the pelvic regions were classified separately. Lymphatic drainage was visualized in 82 of the 86 category cNO-groins, and a total of 115 sentinel nodes were found on scintigraphy and SPECT-CT. A total of 122 sentinel nodes were removed and only 9 tumour positive sentinel nodes were found in 8 patients. All tumour-positive nodes were located in the medial superior quadrant, but 9% of sentinel nodes were located in the lateral superior quadrant and another 18% were found in the central zone. No sentinel nodes were found both in the two inferior quadrants nor in the pelvic regions. This group of patients with few metastatic sentinel nodes can lead one to the conclusion that early nodal metastases may be expected in the central and the two superior Daseler regions, but not in the two lower regions, which can be spared lymph node dissection in early disease. The advantage of this lymph node mapping over the one used by Cabañas is simplicity and improved technology: The principle of lymphangiograms via the dorsal lymphatics of the penis was good, but the defined location of the sentinel lymph node center was not as clear [4,5].

DOI: 10.1016/j.eururo.2008.04.054

Cite this paper

@article{Pizzocaro2008EditorialCO, title={Editorial comment on: Anatomical mapping of lymphatic drainage in penile carcinoma with SPECT-CT: implications for the extent of inguinal lymph node dissection.}, author={Giorgio Pizzocaro}, journal={European urology}, year={2008}, volume={54 4}, pages={892} }