[Lymphatic mapping and sentinel node biopsy in penile cancer: from the cradle of the technique to current...

Lymph node status is the most important prognostic factor in penile squamous cell carcinoma, yet radical inguinal lymph node dissection (ILND) carries substantial morbidity. Sentinel lymph node biopsy was pioneered in penile cancer and subsequently evolved to a concept of dynamic sentinel node biopsy (DSNB), a multidisciplinary staging procedure integrating radiotracer injection, lymphoscintigraphy, intraoperative localization, and pathological ultrastaging with high dianostic efficiency. Over time, gradual improvements including preoperative ultrasonography with fine-needle aspiration cytology (FNAC), SPECT/CT, more refined pathological assessment, and hybrid tracers have reduced false-negative rates improving reliability in experienced centers. Current EAU-ASCO guidance supports DSNB as the preferred surgical strategy to stage patients with intermediate- and high-risk clinically node-negative (cN0) penile cancer. This review summarizes the historical development of penile sentinel node surgery, the current DSNB evidence, the role of modern imaging and hybrid tracers as well as persistent limitations of the approach such as non-visualization, false-negative rate, and other important areas in which further standardization and innovation are needed.