Eur Urol Suppl 2008;7(3):110 157 ANATOMICALMAPPING OF LYMPHATIC DRAINAGE IN PENILE CARCINOMA WITH SPECT-CT Leijte J.A.P. 1 , Valdes Olmos R.A. 2 , Nieweg O.E. , Horenblas S. 1 1 The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Dept. of Urology, Amsterdam, The Netherlands, 2 The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Dept. of Nuclear Medicine, Amsterdam, The Netherlands, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Dept. of Surgery, Amsterdam, The Netherlands Introduction & Objectives: A complementary inguinal lymph node dissection is performed in penile carcinoma patients with a tumour-positive sentinel node. This procedure is associated with high morbidity, such as oedema and infections. A reduced area of dissection could decrease the number of complications. However, earlier attempts proved to be oncologically unsafe. Since 2007, all patients scheduled for sentinel node biopsy at our institute undergo pre-operative SPECT-CT in addition to conventional planar scintigraphy. In this prospective series, we studied the lymphatic drainage pattern of the penis by evaluating the location of the sentinel nodes and higher-tier nodes on the SPECT-CT-images. Material & Methods: A total of 86 clinically node-negative (cN0) inguinal and pelvic regions were evaluated in 50 patients using a hybrid SPECT-CT-scanner. Fused SPECT-CT-images were generated after three zones: the external iliac/obturator zone, the common iliac zone and the para-aortal zone. Results: nodes and 182 higher-tier nodes were found. (Table 1). All sentinel-nodes were located in the groin. The higher-tier nodes were located in the groin and pelvic region. No lymphatic drainage was seen to the inferior two regions of the groin. Drainage zone Location of sentinel nodes (n=115) Location of higher-tier nodes (n=182) Medial superior zone 20 (11%) Lateral superior zone 10 (8.7%) Central zone 8 (4.4%) Medial inferior zone 0 0 Lateral inferior zone 0 0 Iliaca externa/obturatorius zone 0 Iliaca communis zone 0 Paraaortal zone 0 12 (6.6%) Conclusions: All lymphatic drainage of the penis was to the superior and central zones of the groin. procedure. 158 SPECT-CT VISUALIZATION OF TUMOUR-BLOCKAGE AND REROUTING OF LYMPHATIC DRAINAGE IN PATIENTS WITH PENILE CARCINOMA Leijte J.A.P. 1 2 , Nieweg E. , Horenblas S. 1 1 The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Dept. of Urology, Amsterdam, The Netherlands, 2 The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Dept. of Nuclear Medicine, Amsterdam, The Netherlands, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Dept. of Surgery, Amsterdam, The Netherlands Introduction & Objectives: The reliability of sentinel node biopsy is principally been suggested, that extensive metastatic involvement of a sentinel node can lead to negative procedure. Therefore, sentinel node biopsy is generally limited to clinically node-negative (cN0) patients. Recently introduced combined single photon emission computed tomography and CT (SPECT-CT) cameras provide both tomographic lymphoscintigraphy and anatomic detail. This device enabled the study of this concept of tumour-blockage and rerouting in patients with palpable groin metastases. Material & Methods: Fourteen patients with unilateral cN0 groins underwent conventional scintigraphy and SPECT-CT imaging prior to sentinel node biopsy. All 14 patients had cytologically proven metastasis in the contralateral groin. Sentinel node biopsy was performed in cN0 groins, and an inguinal lymph node dissection in the the pattern of lymphatic drainage in the N+ groins and scanned for signs of tumour- blockage or rerouting. Results: the SPECT-CT images. Rerouting of lymphatic drainage to a neo-sentinel node was seen in seven groins, one of which was located in the contralateral groin. Blockage without rerouting was seen in two groins. Conclusions: The assumed concept of tumour-blockage and rerouting was visualized in 64% of the groins with palpable metastases. This underscores the suggested relevance of ultrasound prior to sentinel node biopsy to detect sizeable but non- palpable metastasis. 159 MULTI-INSTITUTIONAL EVALUATION OF DYNAMIC SENTINEL NODE BIOPSY FOR PENILE CARCINOMA Leijte J.A.P. 1 , Hughes B. 2 , Kroon B.K. 1 , Valdes Olmos R.A. , Nieweg O.E. 4 , Corbishley C. 5 , Heenan S. 6 , Watkin N 2 , Horenblas S. 1 1 The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Dept. of Urology, Amsterdam, The Netherlands, 2 St. Georges Hospital, Dept. of Urology, London, United Kingdom, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Dept. of Nuclear Medicine, Amsterdam, The Netherlands, 4 The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Dept. of Surgery, Amsterdam, The Netherlands, 5 St. Georges Hospital, Dept. of Pathology, London, United Kingdom, 6 St. Georges Hospital, Dept. of Radiology, London, United Kingdom Introduction & Objectives: Dynamic sentinel node biopsy (DSNB) has been reported to be a reliable tool to evaluate the nodal status of clinically node-negative (cN0) penile carcinoma patients. However, the use of DSNB is not widespread and the majority of cN0-patients still undergo an elective inguinal lymph node dissection, associated with considerable morbidity. Reservations to the use of DSNB include the fact that current results are mostly from one institution and the supposed long learning curve associated with the procedure. The purpose centres and evaluating the presence of a learning curve. Material & Methods: DSNB was introduced at the NKI in 1994. Until 2001, several patients treated according to the current protocol were included for analysis. At StG, DSNB was introduced in 2004, based on the protocol from the NKI. The sensitivity of DSNB was Results: NKI and 95% at StG. The combined sensitivity was 94%. None of the false-negative cases Conclusions: With the use of an up-to-date protocol, DSNB is a reliable procedure. The In our opinion, DSNB should be the tool of choice to assess cN0 patients. In this way, major morbidity can be spared, without jeopardizing oncological safety. 160 LYMPH NODE METASTASIS IN INTERMEDIATE RISK PENILE SQUAMOUS CELL CANCER– A MULTI-CENTRE EXPERIENCE Hughes B. 1 , Leijte J. 2 , Shabbir M. 1 , Kroon B. 2 , Heenan S. , Corbishley C. 4 , Watkin N. 1 , Horenblas S. 2 1 St Georges Hospital, Dept. of Urology, London, United Kingdom, 2 The Netherlands Cancer Institute, Dept. of Urology, Amsterdam, The Netherlands, St Georges Hospital, Dept. of Radiology, London, United Kingdom, 4 St Georges Hospital, Dept. of Histopathology, London, United Kingdom Introduction & Objectives: The EAU 2004 guidelines state that the risk of lymph node is “intermediate.” In small case series, the risk has been variably described as between 25% and 66%. We have interrogated our combined prospective database of 900 patients to calculate the risk of LNM in G2T1 penile cancer in the largest cohort of penile cancer patients reported. Material & Methods: undergoing inguinal lymph node dissection (iLND), those undergoing dynamic sentinel node biopsy (DSLN) and those who were observed. Nodal staging was recorded in accordance with uro-pathologists. Results: lymph nodes at presentation. All of them underwent iLND of whom 5 had LNM. Of the 106 years of initial diagnosis. Of the 29 patients who were / are being observed (nodal status Nx), The overall risk for lymph node metastasis in G2T1 cancers in our series of 900 patients, whether at presentation or during follow up is 12% (14/115). In clinically node negative patients Conclusions: risk for the development of lymph node metastasis with an overall risk of approximately 12%. false negative rate with dynamic sentinel lymph node sampling we advocate the use of DSLN as a staging tool in evaluating the nodal status of these patients.