Lymphatic Mapping And Sentinel Lymphadenectomy Study

From January 1994, all clinically node-negative patients with squamous cell carcinoma of the penis were enrolled in this study with the exception of patients with T1 tumors or carcinoma in situ. These latter patients are assumed to be at a low risk of having occult metastases. The study group consisted of 40 consecutive patients with a median age of 65 years (range: 28-87 years). Four of these patients presented with a recurrent tumor of the penis after previous penis-conserving therapy. Two patients with palpable unilateral lymph node metastases, proven by fine-needle-aspiration cytology, were included in the study for the clinically unaffected side.

Scintigraphy of lymphatic drainage was performed the day before surgery. An amount of 60 MBq of a technetium-99m (99mTc)-labeled nanocolloid (Nano-coll®, Sorin Radiofarmaci S.r.I., Saluggia, Italy in a volume of 0.3-0.4 mL was injected around the tumor. Immediately after injection, dynamic acquisition was started for a period of 20 minutes using a gamma camera (ADAC Vertex, Milpi-tas, CA) to visualize the lymphatic flow. Subsequently, anterior and lateral static views were obtained for an acquisition duration of 5 min each (Fig. 1) and repeated 2 h after injection. Sentinel nodes were defined as nodes receiving direct drainage from the site of injection. The location of each sentinel node was marked on the skin with a dye. The following day, 1 mL of patent blue dye (Blue Patente

Lymph Nodes Dye Injection Breast
Figure 1 Lymphoscintigram of a 66-year-old patient with a T2 penile carcinoma. From the site of injection (tumor), there is drainage to two sentinel nodes (marked) in the left groin. Several nonsentinel nodes are also clearly seen.

V, Guerbet, Aulney-Sous-Bois, France) was injected intradermally around the tumor in the same way as injection of the radiopharmaceutical (Fig. 2). A few minutes later, a small incision was made over the skin mark. The sentinel node was identified by tracing blue lymphatic channels leading to blue lymph nodes and by using a gamma detection probe (Neoprobe 1000®, Neoprobe Corporation, Dublin, OH). Once identified, the sentinel node was removed and the wound was scanned for remaining radioactivity. Pathological examination consisted of routine paraffin sections and hematoxylin & eosin staining. Immunohistochemi-cal staining using antibodies against pankeratin (Dako, Copenhagen, Denmark) and CAM 5.2 (Becton Dickinson, San Jose, CA) was used only recently. The grade of differentiation was determined according to Broders [14].

Regional lymph node dissection was reserved for patients with a tumorpositive sentinel node. All patients were followed at 2-month intervals during the first 2 years after surgery. The median period of follow-up for all patients was 9 months (range: 18 days to 45 months). One patient was lost to follow-up.

Figure 2 Injection of patent blue dye around the tumor.

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