Interrogating the Impassable: A Case Series and Literature Review of Unilateral SPECT-CT Groin Visualization in Men With Penile Cancer
- Author(s)
- O'Brien, JS; Teh, J; Kelly, BD; Chen, K; Manning, T; Furrer, M; Chee, J; Lawrentschuk, N;
- Journal Title
- Frontiers in Surgery
- Publication Type
- Research article
- Abstract
- Penile squamous cell carcinoma (SCC) is a rare malignancy, which is known to invade local inguinal lymph nodes prior to progressing to the pelvis. Dynamic sentinel lymph node biopsy (DSLNB) is a standard for the minimally invasive assessment of lymphadenopathy in patients with subclinical groin metastasis. Hybrid (99m)Tc Single-Photon Emission Computed Tomography (SPECT-CT) has been shown to increase the accuracy of identifying first draining "sentinel" nodes (SN). Unilateral inguinal visualization on SPECT-CT is a rare presentation, which may increase the likelihood of a false negative SN biopsy. Retrospective analysis from three-penile cancer uro-oncologists in Melbourne, Australia identified 78 groins undergoing DSLNB for intermediate/high risk primary disease. Unilateral SPECT-CT results were observed in four patients suggesting a functional pattern of lymph diversion. Analysis confirmed malignancy (n = 2), sarcoidosis (n = 1), and evidence of local inflammation in SPECT-CT negative groins. Findings re-iterate the role of SPECT-CT a pre-operative adjunct. Experienced multimodal groin assessment using palpation, SPECT-CT, lymphoscintigraphy, and blue dye tracking remains paramount. Unilateral SN on pre-operative SPECT-CT in men with intermediate/high-risk penile SCC should elicit a higher degree of clinical suspicion. We recommend a low threshold for recommending radical inguinal lymph node dissection (ILND) for groins refractory to minimally invasive assessment.
- Keywords
- Spect-ct; dynamic sentinel lymph node biopsy (DSLNB); minimally invasive surgeries (MIS); penile cancer; sentinel node (SN)
- Department(s)
- Surgical Oncology
- PubMed ID
- 35662824
- Publisher's Version
- https://doi.org/10.3389/fsurg.2022.882011
- Open Access at Publisher's Site
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Creation Date: 2025-02-14 04:06:02
Last Modified: 2025-02-14 04:08:15