Transitioning from template-based groin dissection to dynamic sentinel node biopsy in penile cancer: Prospective validation of a standardization step
In brief
Standardized sentinel-node biopsy detected all five metastatic groins in 20 patients
In this small prospective study, the dual-tracer procedure found sentinel nodes in 37 of 40 groins and detected all five with cancer; four successful procedures found nodes outside the usual dissection area. No groin recurrences appeared over a median 34 months, but complications occurred and the results need validation beyond this single-center transition study.
- Journal
- Urologic oncology (Q1)
- Published
- 13 October 2026
- Study design
- Non-randomized / quasi-experimental trial
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Gagan Prakash, Sarah Shaikh, Amandeep Arora, Mahendra Pal, Ankit Misra, Ajit Gujela, et al.
- PMID
- 42869699
- DOI
- 10.1016/j.urolonc.2026.09.009
Why clinicians should know about it
- Picked for Surgical Oncology (paper of the day, 15 October 2026): Dynamic sentinel node biopsy, accurate inguinal staging
Abstract
PURPOSE: Dynamic sentinel lymph node biopsy (DSNB) offers accurate inguinal staging in clinically node-negative (cN0) penile cancer (PeCa), but implementation requires multidisciplinary expertise and standardization. We evaluated the feasibility and diagnostic accuracy of a standardized dual-tracer DSNB protocol during transition from modified/superficial inguinal lymph node dissection (MILD/SILD). METHODS: In this prospective, non-randomized phase II study, 20 patients with intermediate- or high-risk cN0 PeCa underwent DSNB followed by MILD and SILD in both groins. DSNB used 99mTc-nanocolloid and indocyanine green (ICG). Sentinel nodes were identified using lymphoscintigraphy/SPECT-CT, gamma-probe and near-infrared fluorescence, and assessed by frozen section. Final SILD pathology served as the reference standard for calculating the false-negative rate (FNR). RESULTS: Forty groins were evaluated. DSNB successfully identified sentinel nodes in 37/40 (92.5%) groins; ICG identified nodes in 36 (90%) compared with 28 (70%) for 99mTc. Five groins contained metastatic sentinel nodes, all detected by DSNB, yielding 100% sensitivity and 0% FNR. In 4/37 (10.8%) successful procedures, sentinel nodes lay outside the MILD template. Median sentinel node yield was 4 versus 12 nodes with SILD. Median drain duration and hospital stay were 21 and 3 days, respectively. Eleven patients (55%) had no complications; grade 2 and 3a complications occurred in 20% and 25%, respectively. After median follow-up of 34 months, no inguinal nodal recurrences occurred. CONCLUSION: A standardized dual-tracer DSNB protocol was feasible and demonstrated high diagnostic accuracy during phased implementation at a tertiary cancer centre. Initial validation alongside template dissection may facilitate safe adoption, particularly in settings without centralized PeCa services.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.