Discussion

The treatment of patients with penile squamous cell carcinoma and positive lymph nodes is a straightforward regional node dissection, whereas the treatment of patients with clinically normal inguinal nodes is surrounded by controversy. Although it can be argued that early removal of involved nodes is beneficial, elective lymph node dissection results in overtreatment of 80% of the patients [1]. Elective inguinal node dissection should usually be performed on both sides and results in a considerable incidence of postoperative morbidity [2].

Sentinel node biopsy was performed in a recent study of 55 patients with squamous cell carcinoma of the penis [3]. Lymphoscintigraphy revealed bilateral drainage in 43 patients (78%). The sentinel node was always identified and contained metastatic disease in 11 patients (20%). No elective lymph node dissection was performed. After a median follow-up duration of 22 months, two patients returned with involved inguinal nodes after a tumor-free sentinel node had been removed (sensitivity, 85%). The investigators concluded that lymphatic mapping and sentinel node biopsy can be used to select patients with penile cancer who may benefit from inguinal node dissection. And so the sentinel node biopsy returns to the tumor type in which it had originally been described in 1977 [4].

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