EAU & ASCO: Penile Cancer 2023: Difference between revisions

Line 453:

** '''Invasive/surgical staging remains indispensable to identify micro-metastasis before nodal metastases become palpable/visible.'''

** '''Approaches (2)'''

*** '''Dynamic sentinel node biopsy (DSNB) (preferred)'''

**# '''Dynamic sentinel node biopsy (DSNB) (preferred)'''

**** Developed to avoid resecting unnecessary LNs and thereby minimizing the morbidity of surgical staging

**#* Developed to avoid resecting unnecessary LNs and thereby minimizing the morbidity of surgical staging

**** A sentinel node (SN) is defined as the first LN on a direct drainage pathway from the primary tumour.

**#* A sentinel node (SN) is defined as the first LN on a direct drainage pathway from the primary tumour.

***** Based on this concept, it is assumed that if the SN is negative, this indicates the absence of lymphatic tumour spread in the corresponding inguinal basin. In case histopathology identifies SN (micro)metastasis, ipsilateral completion ILND is indicated

**#** Based on this concept, it is assumed that if the SN is negative, this indicates the absence of lymphatic tumour spread in the corresponding inguinal basin. In case histopathology identifies SN (micro)metastasis, ipsilateral completion ILND is indicated

**** High diagnostic accuracy and low complication rates, especially when performed in experienced centres (sensitivity 92–96%, false negative rates 4–8%, complication rate 6–14%)

**#* High diagnostic accuracy and low complication rates, especially when performed in experienced centres (sensitivity 92–96%, false negative rates 4–8%, complication rate 6–14%)

**** '''Technique'''

**#* '''Technique'''

***** '''Inguinal US is obtained prior to DSNB'''

**#** '''Inguinal US is obtained prior to DSNB'''

****** If sonographically suspicious nodes are detected, fine needle aspiration cytology (FNAC) can easily be performed in the same session to confirm the diagnosis of inguinal LN metastasis

**#*** If sonographically suspicious nodes are detected, fine needle aspiration cytology (FNAC) can easily be performed in the same session to confirm the diagnosis of inguinal LN metastasis

******* if US + FNAC is positive, it can reduce the need for DSNB and allow for additional staging and therapeutic LN dissection at an earlier stage

**#**** if US + FNAC is positive, it can reduce the need for DSNB and allow for additional staging and therapeutic LN dissection at an earlier stage

****If DSNB is not available, and referral to a centre with experience with DSNB is not feasible, or if the patient does not want to run the risk of a false-negative procedure, ILND (modified/superficial/video-endoscopic) can be considered after informing the patient of the inherent risk of higher morbidity associated with these procedures.

**#*'''If DSNB is not available, and referral to a centre with experience with DSNB is not feasible, or if the patient does not want to run the risk of a false-negative procedure, ILND (modified/superficial/video-endoscopic) can be considered after informing the patient of the inherent risk of higher morbidity associated with these procedures.'''

*** '''Inguinal lymph node dissection (ILND)'''

**# '''Inguinal lymph node dissection (ILND)'''

**** Radical inguinal lymph node dissection (ILND) is the most accurate surgical staging method, but is associated with the highest complication rates

**#* Radical inguinal lymph node dissection (ILND) is the most accurate surgical staging method, but is associated with the highest complication rates

**** Modified ILND lowers morbidity while maintaining sufficient sensitivity

**#* Modified ILND lowers morbidity while maintaining sufficient sensitivity

***** Modifications in modified ILND

**#** Modifications in modified ILND

****** Shorter skin incision

**#*** Shorter skin incision

****** No dissection lateral to the femoral artery

**#*** No dissection lateral to the femoral artery

****** No dissection caudal to the fossa ovalis

**#*** No dissection caudal to the fossa ovalis

****** Preservation of the saphenous vein

**#*** Preservation of the saphenous vein

****Video-endoscopic/robot-assisted radical LND has been introduced more recently

**#*Video-endoscopic/robot-assisted radical LND has been introduced more recently

*****Similar lymph node yield compared to open

**#**Similar lymph node yield compared to open

*****Reduces wound-related complications compared to open ILND, but no significant reduction in lymphatic complications

**#**Reduces wound-related complications compared to open ILND, but no significant reduction in lymphatic complications

******Main predictor of lymphatic complications is the number of lymph nodes removed

**#***Main predictor of lymphatic complications is the number of lymph nodes removed

* '''Non-surgical staging'''

** '''Imaging'''

@@ Line 453: / Line 453: @@
 ** '''Invasive/surgical staging remains indispensable to identify micro-metastasis before nodal metastases become palpable/visible.'''
 ** '''Approaches (2)'''
-*** '''Dynamic sentinel node biopsy (DSNB) (preferred)'''
+**# '''Dynamic sentinel node biopsy (DSNB) (preferred)'''
-**** Developed to avoid resecting unnecessary LNs and thereby minimizing the morbidity of surgical staging
+**#* Developed to avoid resecting unnecessary LNs and thereby minimizing the morbidity of surgical staging
-**** A sentinel node (SN) is defined as the first LN on a direct drainage pathway from the primary tumour.
+**#* A sentinel node (SN) is defined as the first LN on a direct drainage pathway from the primary tumour.
-***** Based on this concept, it is assumed that if the SN is negative, this indicates the absence of lymphatic tumour spread in the corresponding inguinal basin. In case histopathology identifies SN (micro)metastasis, ipsilateral completion ILND is indicated
+**#** Based on this concept, it is assumed that if the SN is negative, this indicates the absence of lymphatic tumour spread in the corresponding inguinal basin. In case histopathology identifies SN (micro)metastasis, ipsilateral completion ILND is indicated
-**** High diagnostic accuracy and low complication rates, especially when  performed in experienced centres (sensitivity 92–96%, false negative rates 4–8%, complication rate 6–14%)
+**#* High diagnostic accuracy and low complication rates, especially when  performed in experienced centres (sensitivity 92–96%, false negative rates 4–8%, complication rate 6–14%)
-**** '''Technique'''
+**#* '''Technique'''
-***** '''Inguinal US is obtained prior to DSNB'''
+**#** '''Inguinal US is obtained prior to DSNB'''
-****** If sonographically suspicious nodes are detected, fine needle aspiration cytology (FNAC) can easily be performed in the same session to confirm the diagnosis of inguinal LN metastasis
+**#*** If sonographically suspicious nodes are detected, fine needle aspiration cytology (FNAC) can easily be performed in the same session to confirm the diagnosis of inguinal LN metastasis
-******* if US + FNAC is positive, it can reduce the need for DSNB and allow for additional staging and therapeutic LN dissection at an earlier stage
+**#**** if US + FNAC is positive, it can reduce the need for DSNB and allow for additional staging and therapeutic LN dissection at an earlier stage
-****If DSNB is not available, and referral to a centre with experience with DSNB is not feasible, or if the patient does not want to run the risk of a false-negative procedure, ILND (modified/superficial/video-endoscopic) can be considered after informing the patient of the inherent risk of higher morbidity associated with these procedures.
+**#*'''If DSNB is not available, and referral to a centre with experience with DSNB is not feasible, or if the patient does not want to run the risk of a false-negative procedure, ILND (modified/superficial/video-endoscopic) can be considered after informing the patient of the inherent risk of higher morbidity associated with these procedures.'''
-*** '''Inguinal lymph node dissection (ILND)'''
+**# '''Inguinal lymph node dissection (ILND)'''
-**** Radical inguinal lymph node dissection (ILND) is the most accurate surgical staging method, but is associated with the highest complication rates
+**#* Radical inguinal lymph node dissection (ILND) is the most accurate surgical staging method, but is associated with the highest complication rates
-**** Modified ILND lowers morbidity while maintaining sufficient sensitivity
+**#* Modified ILND lowers morbidity while maintaining sufficient sensitivity
-***** Modifications in modified ILND
+**#** Modifications in modified ILND
-****** Shorter skin incision
+**#*** Shorter skin incision
-****** No dissection lateral to the femoral artery
+**#*** No dissection lateral to the femoral artery
-****** No dissection caudal to the fossa ovalis
+**#*** No dissection caudal to the fossa ovalis
-****** Preservation of the saphenous vein
+**#*** Preservation of the saphenous vein
-****Video-endoscopic/robot-assisted radical LND has been introduced more recently
+**#*Video-endoscopic/robot-assisted radical LND has been introduced more recently
-*****Similar lymph node yield compared to open
+**#**Similar lymph node yield compared to open
-*****Reduces wound-related complications compared to open ILND, but no significant reduction in lymphatic complications
+**#**Reduces wound-related complications compared to open ILND, but no significant reduction in lymphatic complications
-******Main predictor of lymphatic complications is the number of lymph nodes removed
+**#***Main predictor of lymphatic complications is the number of lymph nodes removed
 * '''Non-surgical staging'''
 ** '''Imaging'''