Minimal Invasive Management of Lymph Nodes

Penile cancer is a rare genitourinary malignancy. Lymph node involvement is the single most important factor determining survival in these patients, and those patients with occult disease are difficult to identify on conventional cross-sectional imaging. Until recently, lymph node sampling (eg, lymphadenectomy) has been the diagnostic modality of choice in the detection of micrometastasis. More recently, several novel molecular and minimally invasive diagnostic techniques have been developed, which have been demonstrated to decrease the false-negative and -positive results of conventional imaging and lymphadenectomy. This article focuses on the minimally invasive management of lymph nodes in men with penile cancer.

Key points

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Early detection of lymph mode involvement is mandatory, as lymph node involvement in men with penile carcinoma is the most important factor determining survival.
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Approximately 10% to 20% of clinically node-negative patients will harbor occult metastases, which are not detectable on conventional cross-sectional imaging.
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Early resection of the inguinal lymph nodes is associated with a therapeutic benefit, and it is imperative that patients with metastatic disease in the inguinal lymph nodes undergo early inguinal lymphadenectomy.
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Dynamic sentinel biopsy has evolved as a reliable minimally invasive staging technique with an associated sensitivity of 85% to 95% together with a low morbidity for the detection of occult metastasis and should be undertaken as the diagnostic staging modality of choice in men with high-risk clinically node-negative disease.