Skip to main content

Advertisement

SpringerLink
Log in

Radiocolloid-based dynamic sentinel lymph node biopsy in penile cancer with clinically negative inguinal lymph node: an updated systematic review and meta-analysis

  • Urology - Review
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Purpose

More literatures regarding radiocolloid-based dynamic sentinel lymph node biopsy (DSNB) in penile cancer with clinically negative groin (cN0) have been published since previous meta-analysis in 2012. This updated meta-analysis was to assess the accuracy of the procedure in penile cancer with cN0 disease and explore its relative factors on the basis of current evidences.

Materials and methods

We performed a review of PubMed, Ovid/Embase, and the Cochrane Library in March 2016 according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Study quality was evaluated by the use of the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). A random effects model was used for statistical pooling. Publication bias was evaluated by the use of funnel plot and Egger’s test. Meta-regression, subgroup and sensitivity analysis were conducted to explore the sources of heterogeneity.

Results

A total of 27 articles were included. Two articles had two different cohorts and each cohort was considered a separate study. Overall 29 studies were used for sensitivity and negative predictive value (NPV) meta-analysis. The pooled sensitivity and NPV was 88 % (95 % CI 84–90 %) and 99 % (98–99 %), respectively. Meta-regression and subgroup analysis revealed that the use of preoperative ultrasonic scan (USS) ± fine-needle aspiration cytology (FNAC), surgical exploration of wound for suspicious lymph nodes (LN), immunohistochemistry (IHC) and extensive experience were significantly associated with the improved sensitivity of DSNB.

Conclusions

Radiocolloid-based DSNB is a promising staging modality to detect inguinal micrometastasis in penile cancer without clinically positive inguinal LN. Preoperative USS ± FNAC and surgical exploration are effective supplements to exclude potentially clinical involvement, and IHC makes the diagnosis of occult metastasis in SLN more likely. The multidisciplinary and multistep procedure should be performed by skilled teams in specialized centers.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Kroon BK, Horenblas S, Lont AP et al (2005) Patients with penile carcinoma benefit from immediate resection of clinically occult lymph node metastases. J Urol 173(3):816–819

    Article  CAS  PubMed  Google Scholar 

  2. Naumann CM, Filippow N, Seif C et al (2005) Penile carcinoma (pT1 G2): surveillance or inguinal lymph node dissection? Onkologie 28(3):135–138

    PubMed  Google Scholar 

  3. Cabanas RM (1977) An approach for the treatment of penile carcinoma. Cancer 39(2):456–466

    Article  CAS  PubMed  Google Scholar 

  4. Pettaway CA, Pisters LL, Dinney CP et al (1995) Sentinel lymph node dissection for penile carcinoma: the MD Anderson Cancer Center experience. J Urol 154(6):1999–2003

    Article  CAS  PubMed  Google Scholar 

  5. Horenblas S, Jansen L, Meinhardt W et al (2000) Detection of occult metastasis in squamous cell carcinoma of the penis using a dynamic sentinel node procedure. J Urol 163(1):100–104

    Article  CAS  PubMed  Google Scholar 

  6. Tanis PJ, Lont AP, Meinhardt W et al (2002) Dynamic sentinel node biopsy for penile cancer: reliability of a staging technique. J Urol 168(1):76–80

    Article  CAS  PubMed  Google Scholar 

  7. Kroon BK, Horenblas S, Estourgie SH et al (2004) How to avoid false-negative dynamic sentinel node procedures in penile carcinoma. J Urol 171(6Pt1):2191–2194

    Article  CAS  PubMed  Google Scholar 

  8. Kroon BK, Horenblas S, Meinhardt W et al (2005) Dynamic sentinel node biopsy in penile carcinoma: evaluation of 10 years experience. Eur Urol 47(5):601–606 (discussion 606)

    Article  PubMed  Google Scholar 

  9. Leijte JA, Kroon BK, Valdés Olmos RA et al (2007) Reliability and safety of current dynamic sentinel node biopsy for penile carcinoma. Eur Urol 52(1):170–177

    Article  PubMed  Google Scholar 

  10. Jakobsen JK, Krarup KP, Sommer P et al (2016) DaPeCa-1: diagnostic accuracy of sentinel lymph node biopsy in 222 patients with penile cancer at four tertiary referral centres—a national study from Denmark. BJU Int 117(2):235–243

    Article  CAS  PubMed  Google Scholar 

  11. Lam W, Alnajjar HM, La-Touche S et al (2013) Dynamic sentinel lymph node biopsy in patients with invasive squamous cell carcinoma of the penis: a prospective study of the long-term outcome of 500 inguinal basins assessed at a single institution. Eur Urol 63(4):657–663

    Article  PubMed  Google Scholar 

  12. Kirrander P, Andren O, Windahl T (2012) Dynamic sentinel node biopsy in penile cancer: initial experiences at a Swedish referral centre. BJU Int 11(3B):E48–E53

    Google Scholar 

  13. Neto AS, Tobias-Machado M, Ficarra V et al (2011) Dynamic sentinel node biopsy for inguinal lymph node staging in patients with penile cancer: a systematic review and cumulative analysis of the literature. Ann Surg Oncol 18(7):2026–2034

    Article  PubMed  Google Scholar 

  14. Sadeghi R, Gholami H, Zakavi SR et al (2012) Accuracy of sentinel lymph node biopsy for inguinal lymph node staging of penile squamous cell carcinoma: systematic review and meta-analysis of the literature. J Urol 187(1):25–31

    Article  PubMed  Google Scholar 

  15. Moher D, Liberati A, Tetzlaff J et al (2009) PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535

    Article  PubMed  PubMed Central  Google Scholar 

  16. Whiting PF, Rutjes AWS, Westwood ME, the QUADAS-2 Group et al (2011) QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 155(8):529–536

    Article  PubMed  Google Scholar 

  17. Kathiresan N, Raja A, Ramachandran KK et al (2016) Role of dynamic sentinel node biopsy in carcinoma penis with or without palpable nodes. Indian J Urol 32(1):57–60

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Omorphos S, Saad Z, Arya M et al (2016) Feasibility of performing dynamic sentinel lymph node biopsy as a delayed procedure in penile cancer. World J Urol 34(3):329–335

    Article  PubMed  Google Scholar 

  19. Lorenzoni A, Maccauro M, Catanzaro M et al (2015) The reliability of sentinel node biopsy in clinically negative inguinal nodes penile squamous cell carcinoma: the results of a prospective study. Clin Transl Imaging 3:S111

    Article  Google Scholar 

  20. Schubert T, Uphoff J, Henke RP et al (2015) Reliability of radioisotope- guided sentinel lymph node biopsy in penile cancer: verification in consideration of the European guidelines. BMC Urol 15:98

    Article  PubMed  PubMed Central  Google Scholar 

  21. Markuszewski M, Polom W, Cytawa W et al (2015) Comparison of real-time fluorescent indocyanine green and (99 m) Tc-nanocolloid radiotracer navigation in sentinel lymph node biopsy of penile cancer. Clin Genitourin Cancer 13(6):574–580

    Article  PubMed  Google Scholar 

  22. Jakobsen JK, Alslev L, Ipsen P et al (2015) 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. BJU Int. doi:10.1111/bju.13243

    Google Scholar 

  23. Dimopoulos P, Christopoulos P, Shilito S, et al. (2015) Dynamic sentinel lymph node biopsy for penile cancer: a comparison between one and two-day protocols. BJU Int. doi:10.1111/bju.13389

  24. Gómez-Ferrer Á, Rubio J, Collado A et al (2015) Dynamic sentinel node biopsy in penile cancer. Indications, technique and results in a Spanish oncological center. Arch Esp Urol 68(6):524–530

    PubMed  Google Scholar 

  25. Noel JP, Pal RP, Goddard JC et al (2014) Dynamic sentinel lymph node biopsy in penile cancer: a single centre experience. BJU Int 113:53

    Google Scholar 

  26. Djajadiningrat RS, Teertstra HJ, van Rhijn BWG et al (2013) Value of dynamic sentinel node biopsy, ultrasound and fine needle aspiration in the detection of metastatic lymph nodes in penile cancer. Eur Urol Supplements 12(1):e394–e395

    Article  Google Scholar 

  27. Donat R, McFee S (2012) Is sentinel inguinal lymph node biopsy a reproducible treatment option in penile cancer? J Sex Med 9:370

    Google Scholar 

  28. Torelli T, Catanzaro M, Piva L et al (2011) Contralateral dynamic sentinel node biopsy in patients with monolateral inguinal node metastases of penile cancer. Anticancer Res 31(5):1826

    Google Scholar 

  29. Von Forstner C (2011) Improvement of the surgical procedure for penile carcinoma by sentinel lymph node scintigraphy with SPECT and SPECT/CT. Int J Comput Assist Radiol Surg 6:S352

    Google Scholar 

  30. Lemstra C, de Jong I, Leliveld A et al (2010) Evaluation of lymphoscintigraphy and sentinel node biopsy in patients with penile carcinoma. J Nucl Med 51(suppl 2):2004

    Google Scholar 

  31. Leijte JA, Hughes B, Graafland NM et al (2009) Two-center evaluation of dynamic sentinel node biopsy for squamous cell carcinoma of the penis. J Clin Oncol 27(20):3325–3329

    Article  PubMed  Google Scholar 

  32. Rubí S, Vidal-Sicar S, Ortega M et al (2008) Localization of sentinel node in squamous cell carcinoma of the penis. Initial experience. Rev Esp Med Nucl 27(1):3–7

    Article  PubMed  Google Scholar 

  33. Ferreira U, Ribeiro MAV, Reis LO et al (2008) Sentinel lymph node biopsy in penile cancer: a comparative study using modified inguinal dissection. Int Braz J Urol 34(6):725–730

    Article  PubMed  Google Scholar 

  34. Hernández-Toris N, Quintero-Becerra J et al (2007) Lymphatic mapping and sentinel node biopsy in penis cancer. Feasibility study and preliminary report. Cir Cir 75(2):87–91

    PubMed  Google Scholar 

  35. Spiess PE, Izawa JI, Bassett R et al (2007) Preoperative lymphoscintigraphy and dynamic sentinel node biopsy for staging penile cancer: results with pathological correlation. J Urol 177(6):2157–2161

    Article  PubMed  Google Scholar 

  36. Gonzaga-Silva LF, Tavares JM, Freitas FC et al (2007) The isolated gamma probe technique for sentinel node penile carcinoma detection is unreliable. Int Braz J Urol 33(1):58–63 (discussion 64–67)

    Article  PubMed  Google Scholar 

  37. Brennhovd B, Johnsrud K, Berner A et al (2006) Sentinel node procedure in low-stage/low-grade penile carcinomas. Scand J Urol Nephrol 40(3):204–207

    Article  PubMed  Google Scholar 

  38. Perdonà S, Autorino R, De Sio M et al (2005) Dynamic sentinel node biopsy in clinically node-negative penile cancer versus radical inguinal lymphadenectomy: a comparative study. Urology 66(9):1282–1286

    Article  PubMed  Google Scholar 

  39. Akduman B, Fleshner NE, Ehrlich L et al (2001) Early experience in intermediate-risk penile cancer with sentinel node identification using the gamma probe. Urology 58(1):65–68

    Article  CAS  PubMed  Google Scholar 

  40. Deeks JJ, Higgins JPT, Altman DG (eds) (2008) Chapter 9: analysing data and undertaking meta-analyses. In: Higgins JPT, Green S (eds) Cochrane handbook for systematic reviews of interventions. Version 5.0.1 [updated September 2008]. The Cochrane Collaboration, 2008. Available from www.cochrane-handbook.org

  41. Leijte JA, van der Ploeg IM, Valdes Olmos RA et al (2009) Visualization of tumor blockage and rerouting of lymphatic drainage in penile cancer patients by use of SPECT/CT. J Nucl Med 50(3):364–367

    Article  PubMed  Google Scholar 

  42. Dummer R, Hauschild A, Guggenheim M et al (2012) ESMO Guidelines Working Group. Cutaneous melanoma: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 23(Suppl 7):86–91

    Article  Google Scholar 

  43. Senkus E, Kyriakides S, Penault-Llorca F et al (2013) Primary breast cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 24:7–23

    Article  Google Scholar 

  44. Jakobsen JK (2015) Sentinel node biopsy in uro-oncology: a history of the development of a promising concept. Urol Oncol 2015(33):486–493

    Article  Google Scholar 

  45. Brouwer OR, van den Berg NS, Matheron HM et al (2014) Feasibility of intraoperative navigation to the sentinel node in the groin using preoperatively acquired single photon emission computerized tomography data: transferring functional imaging to the operating room. J Urol 192(6):1810–1816

    Article  PubMed  Google Scholar 

  46. Brouwer OR, Buckle T, Vermeeren L et al (2012) Comparing the hybrid fluorescent-radioactive tracer indocyanine green-Tc-99 m-nanocolloid with Tc-99 m-nanocolloid for sentinel node identification: a validation study using lymphoscintigraphy and SPECT/CT. J Nucl Med 53(7):1034–1040

    Article  CAS  PubMed  Google Scholar 

  47. Brouwer OR, van den Berg NS, Matheron HM et al (2014) A hybrid radioactive and fluorescent tracer for sentinel node biopsy in penile carcinoma as a potential replacement for blue dye. Eur Urol 65(3):600–609

    Article  CAS  PubMed  Google Scholar 

  48. Ebbens GA, Pouw B, Hellingman D et al (2015) Our experiences with reinjections for non-visualisation in sentinel lymph node procedures for penile cancer. Eur J Nucl Med Mol I 42(1 Suppl 1):S851

    Google Scholar 

  49. Catanzaro MA, Torelli T, Nicolai N et al (2011) Reliability and safety of dynamic sentinel node biopsy in clinically inguinal node-negative penile squamous cell carcinoma. Anticancer Res 31(5):1827–1828

    Google Scholar 

Download references

Compliance with ethical standards

This work was supported by the Science and Technology Foundation of the Sichuan Province (2014JY0183 to Lu Yi-ping) and the Science and Technology Foundation of the Chengdu City (2014-HM01-00301-SF to Lu Yi-ping).

Conflict of interest

All authors in the study declare no conflict of interests.

Human and animal rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Author information

Authors and Affiliations

  1. Department of Urology, Institute of Urology, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, Sichuan, 610041, People’s Republic of China

    Zi-jun Zou, Zhi-hong Liu, Liang-you Tang, Yu-jie Wang, Jia-yu Liang, Ruo-cheng Zhang, Yong-quan Tang & Yi-ping Lu

Authors
  1. Zi-jun Zou
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zhi-hong Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Liang-you Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yu-jie Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jia-yu Liang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ruo-cheng Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yong-quan Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yi-ping Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yi-ping Lu.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zou, Zj., Liu, Zh., Tang, Ly. et al. Radiocolloid-based dynamic sentinel lymph node biopsy in penile cancer with clinically negative inguinal lymph node: an updated systematic review and meta-analysis. Int Urol Nephrol 48, 2001–2013 (2016). https://doi.org/10.1007/s11255-016-1405-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-016-1405-x

Keywords

Search

Navigation