PREDICTING REGIONAL LYMPH-NODE METASTASIS IN CARCINOMA OF THE PENIS -A COMPARISON BETWEEN FINE-NEEDLE ASPIRATION CYTOLOGY, SENTINEL LYMPH-NODE BIOPSY AND MEDIAL INGUINAL LYMPH-NODE BIOPSY

Objective To evaluate the accuracy of clinical examination and fine-ne edle aspiration cytology (FNAC) in detecting groin metastases in patie nts with carcinoma of the penis, and to assess the positive and negati ve predictive value (PPV, NPV) of a preliminary sentinel lymph-node bi opsy (SNB) and biopsy of the most medial of the horizontal group of in guinal lymph nodes (MIN) in selecting patients for an ilio-inguinal bl ock dissection. Patients and methods The study comprised 28 patients ( 56 groins) with Stage I(one), Stage II (11) and Stage III (16) carcino ma of the penis, All patients underwent a detailed clinical examinatio n followed by FNAC of the palpable inguinal nodes, and were subsequent ly submitted for block dissection, The MIN, the SN and the rest of the inguinal and iliac nodes were histologically examined separately for metastases. Results The clinical evaluation had a sensitivity of 74%, a specificity of 61%, a PPV of 57% and a NPV of 77%. The corresponding values for FNAC were all 100%, and the specificity and PPV for both M IN and SN were 100%. The sensitivity and NPV of MIN were higher than f or SN, although not significantly so. Conclusion Clinical examination alone is inaccurate in selecting patients with carcinoma of the penis for block dissection, FNAC is accurate and specific when nodes are pal pable; in those with impalpable nodes a preliminary MIN biopsy followe d by SNB if the MIN biopsy is negative will accurately select all pati ents with metastases in the groin nodes. This can be performed by exam ining frozen sections of the lymph nodes; if positive, block dissectio n can be carried out at the same time.