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UROSCAN |
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| Year : 2006 | Volume
: 22
| Issue : 3 | Page : 283 |
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Can inguinal lymph node involvement in carcinoma penis be predicted?
N Gupta, A Srivastava
Department of Urology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
Correspondence Address:
N Gupta
Department of Urology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow
India
 Source of Support: None, Conflict of Interest: None  | Check |
How to cite this article:
Gupta N, Srivastava A. Can inguinal lymph node involvement in carcinoma penis be predicted?. Indian J Urol 2006;22:283 |
Vincenzo Ficarra, Filiberto Zattoni, Walter Artibani andrea Fandella, Guido Martignoni, Giacomo Novara et al. Nomogram Predictive of Pathological Inguinal Lymph NodeInvolvement in Patients With Squamous Cell Carcinoma of the Penis. J Urol. Vol. 175, 1700-1705, May 2006.
 Summary | |  |
The purpose of this paper was to generate a nomogram estimating the risk of pathological inguinal lymph node involvement according to the clinical stage and pathological findings of primary tumor. Data was collected retrospectively for 175 patients who had undergone surgical therapy for squamous cell carcinoma penis at 11 urological centers in Italy. Nomogram was generated using a logistic regression model. It was seen that the presence of palpable lymph nodes, vascular and/ or lymphatic invasion embolization predicted metastatic lymph node involvement. The nomogram thus developed had a good concordance index (0.8) for predicting the lymph node involvement.
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The management of inguinal lymph nodes in squamous cell carcinoma of the penis has always been a topic of debate. The therapeutic benefits of early inguinal lymphadenectomy can be counterbalanced by the high rates of morbidity, postoperative complications and mortality. A relevant aim is optimizing the selection of the patients who could really have the highest survival advantage from inguinal lymphadenectomy, limiting the cases where this surgery might be considered an over treatment with a risk of severe complications. The authors are to be commended for developing the first nomogram in a cohort of patients with squamous cell carcinoma of the penis. This model allows the prediction of the probability of inguinal lymph node involvement according to the clinical and pathological data more commonly used to select the patients suitable for inguinal lymphadenectomy. The nomogram can be used to improve the preoperative counseling of the patients and to support treatment planning. The nomogram thus developed has potential limitations as further validation studies are required to confirm the ability of this nomogram to be applied in different settings of patients. This also holds importance when other modalities for evaluating the presence of lymph node metastasis like dynamic lymphoscintigraphy with high sensitivity and specificity being available. However, the standard of care to date is to assign the patient into low and high risk categories depending upon tumor pathology and to perform staging lymphadenectomy depending upon the pathological findings at groin dissection.
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