Abstract

The 2014 European Association of Urology (EAU) guidelines on Penile cancer recommend dynamic sentinel node biopsy (DSNB) as a standard staging method for intermediate and high risk squamous cell carcinoma of the penis (SCCp), (≥ T1G2), c N0. The aim of this work is to evaluate the false negative rate and morbidity of our DSNB series. Since 2005 to 2014, 23 patients with SCCp and a patient with melanoma of the distal urethra, cN0, underwent DSNB in the urology department of Porto Portuguese Oncology Institute ‐ IPOPFG, EPE, Portugal. Bilateral inguinal ultrasound scan and fine needle aspiration cytology (FNAC) of suspicious inguinal nodes were not performed before DSNB. Lymphoscintigraphy starts in the morning of surgery with peri‐tumoral injection of albumin nanocoloid labeled with 99m Tc. Peri‐operatively, patent blue is injected into the dermis in peri‐tumoral location. The sentinel node is identified during surgery with the aid of lymphoscintigraphy images, a portable probe which detects gamma rays and identification of the blue dye in lymph nodes and vessels. The false negative rate was calculated per patient. The complication rate was calculated per groin within 30 days of DSNB. In 23 patients with SCCp, lymphoscintigraphy was bilateral in 7 patients. Biopsy was bilateral in 11 patients, with a mean number of lymph nodes excised per patient of 2, negative for metastasis in 20 patients. After median follow‐up of 45.5 months, we had a false negative. The false negative rate [1 false negative / (3 true positive + 1 false negative)] was 25%. The complication rate of BDGS per groin was 5.8%, with 2 minor linfoceles (Clavien I). Inguinal ultrasound and FNAC of suspicious lymph nodes before DSNB, although operator‐dependent, seems very important to decrease our false negative rate. The referral of patients with SCCp for DSNB can increase the number of patients undergoing this nodal staging method in Portugal. The DSNB morbidity is minimal.