ArticleInternational urology and nephrology2026
Which penile cancer patients with metastasis in a sentinel node may be spared inguinal lymph node dissection without compromising oncological safety? Development of a low-risk selection model.
Article in International urology and nephrology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTo develop and internally validate a low-risk selection model to guide omission of completion inguinal lymph node dissection (ILND) after a positive dynamic sentinel node biopsy (DSNB) and to identify predictors of an inguinal basin harboring additional inguinal lymph node metastases following a positive DSNB.
methodsData were drawn from the Danish National Penile Cancer Database (DaPeCa-data), comprising patients with penile cancer treated from 2000 to 2025. The analysis included 300 DSNB-positive inguinal basins, and each basin was analyzed independently. Candidate predictors were screened using a penalized logistic regression across multiple imputed datasets, with variables meeting a pre-specified selection threshold carried forward to a confirmatory multivariable model. An exhaustive search across combinations of clinical criteria was used to derive low-risk selection models, subject to a pre-specified safety constraint of a negative predictive value (NPV) ≥ 0.92.
resultsAmong 300 DSNB-positive basins, 188 underwent ILND, of which 33 (18%) had additional nodal metastases. Metastasis size ≥ 10 mm, having more than one positive lymph node at DSNB, and bilateral positive DSNB were the strongest independent predictors of additional metastases after a positive DSNB. A two-criterion model (metastasis size ≤ 10 mm and no urethral invasion) spared 63 out of 248 evaluable basins (25.4%) from ILND, with 5 false-negative cases equal to an NPV of 0.921. A stricter three-criterion model spared 21 out of 248 basins (8.5%) with 1 false negative and an NPV of 0.952. Sensitivity analysis restricted to directly observed outcomes lowered the higher-yield model's NPV to 0.908.
conclusionsIn penile cancer patients with a positive DSNB, the strongest predictors of the presence of additional inguinal lymph node metastases were: sentinel node metastases of 10 mm or more; two or more positive sentinel lymph nodes and bilateral sentinel lymph node metastases. A simple, bedside-usable selection model may safely spare a meaningful subset of DSNB-positive patients from completion ILND, but the prediction performance was sensitive to outcome-imputation assumptions and requires external validation before clinical implementation.
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