Dynamic sentinel node biopsy in penile cancer: 25 years of experience at a tertiary oncological center

Penile cancer lymph node (LN) metastases are critical prognostic factors. The European Association of Urology (EAU) guidelines recommend dynamic sentinel node biopsy (DSNB) as a less invasive alternative for cN0 patients with intermediate- to high-risk tumors. Due to the rarity of penile cancer, lymph node staging tends to be underutilized, and few centers have a significant number of patients to develop the DSNB technique and observe its evolution over time. Previously, our series reported a sensitivity of 66%, and our aim is to contribute to the available evidence, based on 25 years of real-world experience.

Retrospective single-center study involving 95 groins of 51 patients with intermediate or high-risk penile squamous carcinoma, who underwent DSNB between November 1999 and July 2024. Clinical data, including histology, surgical treatment, and complications, were analyzed. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Complications were registered using the Clavien-Dindo system.

The median age of patients was 60 (range 30-84) years. 10/51 patients (21%) had metastatic sentinel node. DSNB successfully identified sentinel nodes in 95.7% for right and 89.5% for left groins. The false-negative rate was 8.1%, with a sensitivity of 77%, specificity of 100%, PPV of 100%, and NPV of 92%. 18% (9/51) of patients suffered complications being most of them minor (6/9), 3 patients experimented major complications.

The updated DSNB outcomes show improved diagnostic accuracy compared to previous reports, reflecting enhanced techniques and learning curves. The study highlights the accuracy and the low morbidity of DSNB.