EAU & ASCO: Penile Cancer 2023: Difference between revisions
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====== Options ====== | ====== Options ====== | ||
* '''Surgical staging''' | * '''<span style="color:#ff0000">Surgical staging''' | ||
** '''Invasive/surgical staging remains indispensable to identify micro-metastasis before nodal metastases become palpable/visible.''' | ** '''Invasive/surgical staging remains indispensable to identify micro-metastasis before nodal metastases become palpable/visible.''' | ||
** '''Approaches (2)''' | ** '''<span style="color:#ff0000">Approaches (2)''' | ||
**# '''Dynamic sentinel node biopsy (DSNB) (preferred)''' | **# '''<span style="color:#ff0000">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. | ||
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**#**** 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)''' | **# '''<span style="color:#ff0000">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 | ||
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**#**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''' | * '''<span style="color:#ff0000">Non-surgical staging''' | ||
** '''Imaging''' | ** '''<span style="color:#ff0000">Imaging''' | ||
*** '''Not reliable to evaluate clinically node-negative patients''' | *** '''<span style="color:#ff0000">Not reliable to evaluate clinically node-negative patients''' | ||
**** Conventional imaging modalities such as US, computed tomography (CT) or MRI cannot detect micrometastases | **** Conventional imaging modalities such as US, computed tomography (CT) or MRI cannot detect micrometastases | ||
****18F-fluoro-2-deoxy-D-glucose positron emission tomography (18FDG-PET) does not detect LN metastases < 10 mm | ****18F-fluoro-2-deoxy-D-glucose positron emission tomography (18FDG-PET) does not detect LN metastases < 10 mm | ||