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Diagnosing metastatic disease in inguinal nodes in penile cancer: Do we have a test and the evidence?

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Author(s): Ananthakrishnan N

Journal: Indian Journal of Urology
ISSN 0970-1591

Volume: 22;
Issue: 4;
Start page: 345;
Date: 2006;
Original page

Keywords: Carcinoma penis | inguinal node metastasis | sentinel node sampling

ABSTRACT
Nodal metastasis is the most important prognostic factor in carcinoma of the penis. Clinical examination is inaccurate for diagnosing nodal involvement. Routine prophylactic block dissection carries a high risk of morbidity and a small but definite incidence of mortality. Procedures such as fine needle aspiration cytology with or without imaging guidance, anatomic sentinel node sampling, medial inguinal lymph node biopsy and dynamic sentinel node mapping, have all been tried, of which the last has proved most useful. Newer investigations like lymphotropic nano-particle enhanced MRI, squamous cell carcinoma antigen estimation and DNA flow cytometry are still experimental. It appears that in spite of numerous tests available for diagnosing metastatic disease in nodes before it becomes clinically apparent, the only test which currently holds promise is dynamic sentinel node mapping using radio isotopes with or without intraoperative colored dye, to identify the draining nodes for sampling. The only other alternative may be to recommend prophylactic node dissection in all T2, T3 or T4 patients or in all patients with Grade 2 or 3 T1 tumors, in whom the risk of nodal metastases is very high.
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