To examine interobserver variations in assessing grade and stage of penile squamous cell carcinoma (SCC).
We retrospectively reviewed the pathological features and clinical outcome in 75 patients with SCC of the penis, who were treated in participating urological centres between 1996 and 2005; the assessments of the local pathologists and the review pathologists were compared.
There was conformity in tumour grade in 67% and the assessment of tumour stage conformed in 84%; the combination assessment of both grade and stage conformed in 56%.
Accurate histological subtyping by the surgical pathologist demands standardized guidelines, in particular for histological grading, which is crucial for clinical treatment, but shows significant interobserver variation.
"Our results are in agreement with a previous study evaluating penile tumors invading 5–10 mm, in which histological grade had more influence on prognosis than depth of tumor invasion (Velazquez et al. 2008). Given its importance and clinical implications histological grading should be carried out using uniform and comparable criteria, moreover considering that a significant interobserver variability has been reported for histological grading in penile carcinomas (Naumann et al. 2009). For patients included in this study, histological grading was carried out using strict (and previously validated) morphologic criteria (Chaux et al. 2009). "
[Show abstract][Hide abstract] ABSTRACT: To report the clinicopathologic and outcome features of superficial high-grade and deep low-grade penile squamous cell carcinomas.
From a retrospectively-collected series of patients with penile cancer we identified 41 cases corresponding to 12 superficial high-grade tumors and 29 deep low-grade tumors. As outcomes we evaluated inguinal lymph node status, presence of tumor relapse, final nodal status, and cancer-specific death. Follow-up ranged from 0.8 to 386.7 months (mean 152.5 months, median 157.3 months).
Clinicopathologic features were similar between superficial high-grade and deep low-grade tumors, except for a tendency (Fisher's exact [Formula: see text]) of the former to include tumors with a verruciform pattern of growth. A significantly higher proportion of inguinal lymph node metastasis was found in superficial high-grade tumors compared to deep low-grade tumors [4/5 (80%) vs. 1/5 (20%) respectively, Fisher's exact [Formula: see text]]. No significant differences were found regarding tumor relapse (Fisher's exact [Formula: see text]), final nodal status (Mantel-Cox's [Formula: see text]), or cancer-related death (Mantel-Cox's [Formula: see text]).
Patients with superficial high-grade tumors had a significantly higher proportion of inguinal lymph node metastasis compared to patients with deep low-grade tumors. On this regard, prophylactic inguinal lymphadenectomy might be indicated in cases of superficial tumors with high-grade histology while in deeply invasive low-grade penile carcinomas a more conservative approach may be considered.
[Show abstract][Hide abstract] ABSTRACT: Hintergrund
Die Vereinigung europäischer Urologen empfiehlt in ihren aktuellen Leitlinien für das Lymphknotenstaging des Peniskarzinoms bei nicht palpablen Leistenlymphknoten die dynamische Lymphknotenbiopsie („dynamic sentinel node biopsy“, DSNB) als diagnostische Methode der ersten Wahl. Ziel dieser Studie war es, die Zuverlässigkeit der DSNB zu überprüfen.
Material und Methoden
Die DSNB wurde zwischen 2004 und 2012 in allen Patienten mit einem invasiven Peniskarzinom und nicht palpablen Leistenlymphknoten angewendet. Als Merkmal der Zuverlässigkeit wurde die Falsch-negativ-Rate bestimmt. Daneben wurden Komplikationen dokumentiert. Die Ergebnisse wurden prospektiv erfasst.
Eine DSNB wurde bei insgesamt 29 Patienten mit palpatorisch unauffälligen Leistenlymphknoten durchgeführt. Bei 2 Patienten wurden Metastasen mit Hilfe der DSNB nachgewiesen, ein Patient entwickelte einen Lymphknotenbefall nach negativer DSNB. Somit ergibt sich eine Falsch-negativ-Rate von 3,70 %. Die Morbiditätsrate lag bei 3,45 %.
Die Sentinel-Lymphknotenbiopsie ist eine zuverlässige diagnostische Methode. Die hohen methodischen wie auch logistischen Anforderungen legen nahe, dass sie nur in ausgewählten Zentren durchgeführt werden sollte.
Der Urologe 10/2013; 52(10). DOI:10.1007/s00120-013-3166-9 · 0.44 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The European Association of Urology (EAU) guidelines advise an elective bilateral lymphadenectomy in clinically node-negative (cN0) patients with high-risk penile carcinoma (≥pT2, G3, or lymphovascular invasion [LVI]).
Our aim was to assess prognostic factors for occult metastasis and to determine whether current EAU guidelines accurately stratify patients at high risk.
Data of 342 cN0 patients with histologically proven invasive penile squamous cell carcinoma who had undergone the current dynamic sentinel node biopsy (DSNB) protocol were analysed. A complete ipsilateral inguinal lymphadenectomy was only done if the sentinel node was tumour positive.
The presence of occult metastasis was established by preoperative ultrasound and tumour-positive fine-needle aspiration cytology, tumour-positive sentinel nodes, and groin metastases during follow-up after a negative DSNB procedure. Median follow-up was 31 mo.
Sixty-eight of 342 patients (20%) and 87 of 684 groins (13%) had occult nodal involvement including 6 patients (2%) with a groin metastasis after negative DSNB. Corpus spongiosum invasion, corpus cavernosum invasion, histologic grade, and LVI were each significant prognosticators for occult metastasis on univariate analysis. On multivariate analysis, grade (odds ratio [OR]: 3.3 for intermediate and 4.9 for poor, respectively) and LVI (OR: 2.2) remained predictive factors. In total, 245 patients (72%) were classified high risk according to EAU guidelines. Among them, the incidence of occult metastasis was 23% (57 of 245). A potential limitation of this study is the lack of external review.
Histologic grade and LVI are independent prognostic factors for occult metastasis in penile carcinoma. Although both predictors are incorporated into the current EAU guidelines, the stratification of patients needing a lymph node dissection is inaccurate. Approximately 77% of high-risk patients (188 of 245) would have had a negative bilateral inguinal lymphadenectomy. For the time being, DSNB is considered a more suitable staging method than EAU risk stratification for an accurate determination of patients who require lymph node dissection.
European Urology 11/2010; 58(5):742-7. DOI:10.1016/j.eururo.2010.08.015 · 13.94 Impact Factor
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