Presentation Authors: Rachel A Khaw*, Manchester, United Kingdom, Joren Van Thoor, Maarten Albersen, Leuven, Belgium, Pedro Oliveira, Tony Elliott, Vijay Sangar, Maurice Lau, Arie Parnham, Manchester, United Kingdom
Introduction: Prognosis of penile squamous cell carcinoma is determined by TNM staging. Inguinal nodal involvement can be associated with poor survival; therefore investigation of both clinically palpable and non-palpable nodes is imperative. Current management of positive nodes found through sentinel lymph node biopsy (SLNB) involves completion inguinal lymph node dissection (ILND). The need for completion ILND in patients with SLNB micro-metastasis is debatable. This retrospective two-centre eUROGEN cohort study investigates outcomes in patients with SLNB micro metastasis who go on to completion ILND.
Methods: All patients with clinically non-palpable inguinal nodes underwent SLNB. Sentinel nodes were examined histologically, and the maximum diameter of any metastasis recorded. Any sentinel node containing a metastasis measuring â‰¤2mm was classified as having a micro-metastasis as defined by the TNM 8th ed. All tumour positive sentinel node cases underwent completion ILND. Tumour characteristics including staging and grading were recorded, in addition to histopathological findings of the ILND, local recurrence rates and follow-up.
Results: A total of 421 inguinal regions in 240 patients with varying stages of disease (T1-3, G1-2) were included. Mean age was 64 (33-90) years. The median number of lymph nodes excised from each inguinal region at the time of SLNB was 2 (range 1-8). There were 50 cases which were tumour-positive (11.9%). Of these 50 cases, micro-metastases were found in 9 cases (18%), mean diameter 1.00mm (0.2-2.0mm). Completion ILND was performed in 7 of these cases (78%). No further positive nodes were noted in the completion ILND specimen. There were 0 local recurrences with a mean follow-up of 33 (12-76) months. _x000D_
In the two cases not undergoing completion ILND following positive identification of micro-metastases, one had isolated tumour cells and had no evidence of recurrence at 11 months. The second patient developed progressive disease from the contralateral side.
Conclusions: Patients undergoing SLNB that shows micro-metastases are unlikely to have further disease in completion ILND samples, and unlikely to have local recurrence. However, it is not yet possible to recommend avoiding completion ILND in such patients. eUROGEN will work towards a large multicentre study to answer this important question.