Can regional lymph node involvement be predicted in patients with carcinoma of the penis?

To detect the incidence of metastases in regional nodes (inguinal and external iliac) in patients with carcinoma of the penis and to determine whether nodal involvement was predictable pre-operatively by clinical and histological parameters.

Seventy-eight patients who in total had undergone 135 groin dissections were studied. The incidence of inguinal and iliac node metastases was correlated with factors such as the size of the nodes, the histological degree of differentiation, the extent of penile involvement by the primary tumour and the clinical palpability of the iliac nodes.

The incidence of metastases to the inguinal and iliac nodes was 74% and 32% of patients respectively. The risk of involvement was equal on both sides irrespective of whether the nodes were palpable. Inguinal nodes larger than 2 cm in diameter and poor histological differentiation of the primary tumour were significant predictors of inguinal node involvement. The palpability of the iliac nodes, inguinal nodes larger than 2 cm and the fixity of the inguinal nodes were important indicators of metastases to iliac nodes. Extension of the primary tumour to the proximal shaft of the penis was associated with a significantly higher incidence of inguinal node but not iliac node metastases. None of the parameters studied identified all the patients with nodal metastases.

In the absence of any reliable predictor of nodal metastases, all patients with carcinoma of the penis required an intensive and continued follow-up to detect signs of nodal involvement. In developing countries however, where patients do not come for regular follow-up and often present with fungating inguinal secondaries, a policy of early bilateral regional node clearance despite the level of morbidity is preferable.