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395 A Comparison of techniques in sentinel lymph node biopsy for penile cancer
395
A Comparison of techniques in sentinel lymph node biopsy for penile cancer Eur Urol Suppl 2013;12;e395
Shillito S.H.1, Sangar V.K.S.2, Murby B.2, Ashworth D.2, Parr N.R.2, Taylor B.2, Lau M.W.2 1University of Manchester, Dept. of Urology, Manchester, United Kingdom, 2Christie Hopsital, Dept. of Urology,
Manchester, United Kingdom INTRODUCTION & OBJECTIVES: Dynamic sentinel node biopsy is a technique used to detect occult inguinal node metastasis in intermediate and high risk penile cancer patients with clinically node negative groins. This study examines the false negative rate and associated morbidity of sentinel node biopsy from a tertiary referral centre. It examines the results of a 1 day protocol for sentinel biopsy which has recently been introduced where lymphoscintigraphy and surgery occur on the same day. This is compared with the results of a more established 2 day protocol where lymphoscintigraphy takes place the day before surgery. MATERIAL & METHODS: The results of 213 groins operated on between 2009 and 2012 were retrospectively analyzed. 45 groins were managed with a 1 day protocol and 168 were managed using a 2 day protocol. 100% of groins had negative findings following ultrasound scanning with or without fine needle aspiration prior to surgery. (Any groins noted positive on USS were not included in this analysis.) Complication rates were graded according to the Clavien Dindo classification system. Any documented evidence of recurrence in groins found to have a negative sentinel node was recorded. RESULTS: From the 213 groins, sentinel nodes were successfully removed in 212 groins giving an overall detection rate of 99.5% (median overall follow-up 14 months (range 0-45 months)). Radioactive marker and blue dye detection was 98.6% and 74.4% respectively. 17 sentinel nodes were positive for metastasis (8%). 3 false negative groins have presented giving a false negative rate of 15%. Overall complication rate was 28% with the majority being low grade complications. Median follow up for the 1 and 2 day groups was 4 months and 16 months respectively. All false negative groins came from the 2 day protocol group although this was not statistically significant. More nodes in addition to the sentinel node were removed per groin using a 1 day protocol (average 1.93 total nodes removed compared to 1.54 nodes. p=0.001) with higher radioactive counts in the sentinel nodes for the 1 day group (p<0.001). Complication rates were higher in the 1 day group (41% compared to 24%. p=0.026). CONCLUSIONS: The overall false negative rate and complication rate is higher than recent published data. Complication rates are higher in 1 day rather than 2 day protocols, and this may be due to higher radioactivity of nodes at the time of surgery leading to more nodes being removed per groin however other unidentified biases could exist. Longer follow up and higher numbers of groins are required to confirm the false negative rate and differences in the 1 and 2 day protocols.
A Comparison of techniques in sentinel lymph node biopsy for penile cancer Eur Urol Suppl 2013;12;e395
Shillito S.H.1, Sangar V.K.S.2, Murby B.2, Ashworth D.2, Parr N.R.2, Taylor B.2, Lau M.W.2 1University of Manchester, Dept. of Urology, Manchester, United Kingdom, 2Christie Hopsital, Dept. of Urology,
Manchester, United Kingdom INTRODUCTION & OBJECTIVES: Dynamic sentinel node biopsy is a technique used to detect occult inguinal node metastasis in intermediate and high risk penile cancer patients with clinically node negative groins. This study examines the false negative rate and associated morbidity of sentinel node biopsy from a tertiary referral centre. It examines the results of a 1 day protocol for sentinel biopsy which has recently been introduced where lymphoscintigraphy and surgery occur on the same day. This is compared with the results of a more established 2 day protocol where lymphoscintigraphy takes place the day before surgery. MATERIAL & METHODS: The results of 213 groins operated on between 2009 and 2012 were retrospectively analyzed. 45 groins were managed with a 1 day protocol and 168 were managed using a 2 day protocol. 100% of groins had negative findings following ultrasound scanning with or without fine needle aspiration prior to surgery. (Any groins noted positive on USS were not included in this analysis.) Complication rates were graded according to the Clavien Dindo classification system. Any documented evidence of recurrence in groins found to have a negative sentinel node was recorded. RESULTS: From the 213 groins, sentinel nodes were successfully removed in 212 groins giving an overall detection rate of 99.5% (median overall follow-up 14 months (range 0-45 months)). Radioactive marker and blue dye detection was 98.6% and 74.4% respectively. 17 sentinel nodes were positive for metastasis (8%). 3 false negative groins have presented giving a false negative rate of 15%. Overall complication rate was 28% with the majority being low grade complications. Median follow up for the 1 and 2 day groups was 4 months and 16 months respectively. All false negative groins came from the 2 day protocol group although this was not statistically significant. More nodes in addition to the sentinel node were removed per groin using a 1 day protocol (average 1.93 total nodes removed compared to 1.54 nodes. p=0.001) with higher radioactive counts in the sentinel nodes for the 1 day group (p<0.001). Complication rates were higher in the 1 day group (41% compared to 24%. p=0.026). CONCLUSIONS: The overall false negative rate and complication rate is higher than recent published data. Complication rates are higher in 1 day rather than 2 day protocols, and this may be due to higher radioactivity of nodes at the time of surgery leading to more nodes being removed per groin however other unidentified biases could exist. Longer follow up and higher numbers of groins are required to confirm the false negative rate and differences in the 1 and 2 day protocols.