Interrogating the Impassable: A Case Series and Literature Review of Unilateral SPECT-CT Groin Visualization in Men With Penile Cancer

Overview

Journal Front Surg

Specialty General Surgery

Date 2022 Jun 6

PMID 35662824

Authors

Jonathan S OBrien

Jiasian Teh

Brian D Kelly

Kenneth Chen

Todd Manning

Marc Furrer

Justin Chee

Nathan Lawrentschuk

Affiliations

Soon will be listed here.

Abstract

Penile squamous cell carcinoma (SCC) is a rare malignancy, which is known to invade local inguinal lymph nodes prior to progressing to the pelvis. Dynamic sentinel lymph node biopsy (DSLNB) is a standard for the minimally invasive assessment of lymphadenopathy in patients with subclinical groin metastasis. Hybrid Tc Single-Photon Emission Computed Tomography (SPECT-CT) has been shown to increase the accuracy of identifying first draining "sentinel" nodes (SN). Unilateral inguinal visualization on SPECT-CT is a rare presentation, which may increase the likelihood of a false negative SN biopsy. Retrospective analysis from three-penile cancer uro-oncologists in Melbourne, Australia identified 78 groins undergoing DSLNB for intermediate/high risk primary disease. Unilateral SPECT-CT results were observed in four patients suggesting a functional pattern of lymph diversion. Analysis confirmed malignancy ( = 2), sarcoidosis ( = 1), and evidence of local inflammation in SPECT-CT negative groins. Findings re-iterate the role of SPECT-CT a pre-operative adjunct. Experienced multimodal groin assessment using palpation, SPECT-CT, lymphoscintigraphy, and blue dye tracking remains paramount. Unilateral SN on pre-operative SPECT-CT in men with intermediate/high-risk penile SCC should elicit a higher degree of clinical suspicion. We recommend a low threshold for recommending radical inguinal lymph node dissection (ILND) for groins refractory to minimally invasive assessment.

References

Leijte J, Kroon B, Olmos R, Nieweg O, Horenblas S . Reliability and safety of current dynamic sentinel node biopsy for penile carcinoma. Eur Urol. 2007; 52(1):170-7. DOI: 10.1016/j.eururo.2007.01.107. View

Moher D, Liberati A, Tetzlaff J, Altman D . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009; 6(7):e1000097. PMC: 2707599. DOI: 10.1371/journal.pmed.1000097. View

Saad Z, Omorphos S, Michopoulou S, Gacinovic S, Malone P, Nigam R . Investigating the role of SPECT/CT in dynamic sentinel lymph node biopsy for penile cancers. Eur J Nucl Med Mol Imaging. 2017; 44(7):1176-1184. PMC: 5434125. DOI: 10.1007/s00259-017-3636-1. View

Kirrander P, Andren O, Windahl T . Dynamic sentinel node biopsy in penile cancer: initial experiences at a Swedish referral centre. BJU Int. 2012; 111(3 Pt B):E48-53. DOI: 10.1111/j.1464-410X.2012.11437.x. View

Alnajjar H, Lam W, Bolgeri M, Rees R, Perry M, Watkin N . Treatment of carcinoma in situ of the glans penis with topical chemotherapy agents. Eur Urol. 2012; 62(5):923-8. DOI: 10.1016/j.eururo.2012.02.052. View

Graafland N, Lam W, Leijte J, Yap T, Gallee M, Corbishley C . Prognostic factors for occult inguinal lymph node involvement in penile carcinoma and assessment of the high-risk EAU subgroup: a two-institution analysis of 342 clinically node-negative patients. Eur Urol. 2010; 58(5):742-7. DOI: 10.1016/j.eururo.2010.08.015. View

Sadeghi R, Gholami H, Zakavi S, Dabbagh Kakhki V, Horenblas S . Accuracy of 18F-FDG PET/CT for diagnosing inguinal lymph node involvement in penile squamous cell carcinoma: systematic review and meta-analysis of the literature. Clin Nucl Med. 2012; 37(5):436-41. DOI: 10.1097/RLU.0b013e318238f6ea. View

Kroon B, Valdes Olmos R, Nieweg O, Horenblas S . Non-visualization of sentinel lymph nodes in penile carcinoma. Eur J Nucl Med Mol Imaging. 2005; 32(9):1096-9. DOI: 10.1007/s00259-005-1822-z. View

Sahdev V, Albersen M, Christodoulidou M, Parnham A, Malone P, Nigam R . Management of non-visualization following dynamic sentinel lymph node biopsy for squamous cell carcinoma of the penis. BJU Int. 2016; 119(4):573-578. DOI: 10.1111/bju.13680. View

10.

Bray F, Ferlay J, Soerjomataram I, Siegel R, Torre L, Jemal A . Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018; 68(6):394-424. DOI: 10.3322/caac.21492. View

11.

Stuiver M, Djajadiningrat R, Graafland N, Vincent A, Lucas C, Horenblas S . Early wound complications after inguinal lymphadenectomy in penile cancer: a historical cohort study and risk-factor analysis. Eur Urol. 2013; 64(3):486-92. DOI: 10.1016/j.eururo.2013.02.037. View

12.

OBrien J, Teh J, Chen K, Kelly B, Chee J, Lawrentschuk N . Dynamic Sentinel Lymph Node Biopsy for Penile Cancer: Accuracy is in the Technique. Urology. 2022; 164:e308. DOI: 10.1016/j.urology.2022.02.014. View

13.

Leijte J, van der Ploeg I, Olmos R, Nieweg O, Horenblas S . Visualization of tumor blockage and rerouting of lymphatic drainage in penile cancer patients by use of SPECT/CT. J Nucl Med. 2009; 50(3):364-7. DOI: 10.2967/jnumed.108.059733. View

14.

Kayes O, Minhas S, Allen C, Hare C, Freeman A, Ralph D . The role of magnetic resonance imaging in the local staging of penile cancer. Eur Urol. 2006; 51(5):1313-8. DOI: 10.1016/j.eururo.2006.11.014. View