DaPeCa‐3: promising results of sentinel node biopsy combined with 18 F‐fluorodeoxyglucose positron emission tomography/computed tomography in clinically lymph node‐negative patients with penile cancer – a national study from Denmark
Objectives To estimate the diagnostic accuracy of sentinel node biopsy ( SNB ) combined with preoperative 18 F‐fluorodeoxyglucose positron emission tomography/computed tomography ( FDG PET / CT ) for inguinal lymph node ( LN ) evaluation in patients with invasive penile squamous cell carcinoma ( PSC...
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Published in | BJU international Vol. 118; no. 1; pp. 102 - 111 |
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Main Authors | , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
01.07.2016
|
Online Access | Get full text |
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Summary: | Objectives
To estimate the diagnostic accuracy of sentinel node biopsy (
SNB
) combined with preoperative
18
F‐fluorodeoxyglucose positron emission tomography/computed tomography (
FDG PET
/
CT
) for inguinal lymph node (
LN
) evaluation in patients with invasive penile squamous cell carcinoma (
PSCC
) with no clinical evidence of inguinal metastases (
cN
0) at two tertiary centres with complete clinical follow‐up.
Patients and Methods
From April 2010 in Centre one and from January 2013 in Centre two, we prospectively enrolled patients diagnosed with invasive
PSCC
and scheduled for
SNB
at the only two university centres treating penile cancer in Denmark. All patients had
FDG PET
/
CT
before
SNB
. The sentinel
LN
s were preoperatively located by planar lymphoscintigraphy in 134 groins (68 patients) and by single‐photon emission
CT
/
CT
in 120 groins (61 patients). The primary endpoints were the sensitivity, specificity, and false‐negative rate of
SNB
combined with
FDG PET
/
CT
. The secondary endpoint was
SNB
‐related morbidity.
Results
We examined 254 groins in 129 patients by
SNB
combined with
FDG PET
/
CT
. The median (interquartile range,
IQR
) follow‐up of survivors was 23 (14–35) months. Of 201
LN
‐negative groins, two were false negatives, and despite radio‐chemotherapy treatment, both patients died from penile cancer. Four of 23 radiotracer‐silent groins, had a
FDG PET
/
CT
‐positive
LN
s and were surgically explored. In one of four of the explored groins, a positive
LN
was found. Combined
FDG PET
/
CT
‐
SNB
sensitivity was 94.4% (95% confidence interval [
CI
] 81–99%) per groin. The false‐negative rate was 5.6% (95%
CI
1–19%) per groin. In 15 patients (11.6%) there were 25
SNB
‐related complications of Clavien–Dindo grades I–
III
a. The only Clavien–Dindo
III
a complication was an inguinal lymphocele treated by aspiration.
Conclusion
In this study, we present a favourable
SNB
false‐negative rate of 5.6% in a national cohort of clinically
LN
‐negative patients with invasive
PSCC
with a pre‐
SNB FDG PET
/
CT
scan. The combination of
FDG PET
/
CT
and
SNB
seems to be a promising diagnostic approach. Even so, a false‐negative
SNB
was fatal in two of two cases and we are determined to continue the development of our
SNB
technique. The
SNB
‐related morbidity was limited. |
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ISSN: | 1464-4096 1464-410X |
DOI: | 10.1111/bju.13243 |