{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T19:21:08Z","timestamp":1792783268525,"version":"4.5.0"},"reference-count":24,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T00:00:00Z","timestamp":1789776000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T00:00:00Z","timestamp":1789776000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100009708","name":"Novo Nordisk Fonden","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100009708","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Aarhus Universitet","id":[{"id":"https:\/\/ror.org\/01aj84f44","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Int Urol Nephrol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data 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) \u2265\u20090.92.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 300 DSNB-positive basins, 188 underwent ILND, of which 33 (18%) had additional nodal metastases. Metastasis size \u2265\u200910\u00a0mm, 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 \u2264\u200910\u00a0mm 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In 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\u00a0mm 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11255-026-05398-5","type":"journal-article","created":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T03:15:41Z","timestamp":1789787741000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["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"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-6880-9281","authenticated-orcid":false,"given":"J.","family":"M\u00f8lsted","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. B.","family":"Als","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. B.","family":"Jensen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Aagaard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. K.","family":"Jakobsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,19]]},"reference":[{"key":"5398_CR1","unstructured":"Brouwer OR, Albersen M, Ayres B, Crook J, van der Heijden MS, Johnstone PAS, Oliveira P, Parnham A, Pettaway CA, Protzel C, Rumble RB, S\u00e1nchez Mart\u00ednez D (2026) P.E. Spiess Patient Advocates: K. Manzie, J.D. Marcus, J. Osborne, L. Barreto, K. Patterson, H.A. Garcia-Perdomo, I. Greco, C. Bezuidenhout. European Association of Urology-American Society of Clinical Oncology Collaborative Guideline on Penile Cancer: 2026 Update. Eur Urol. ISBN 978-94-92671-32-5."},{"issue":"5","key":"5398_CR2","doi-asserted-by":"publisher","first-page":"1075","DOI":"10.1016\/j.eururo.2009.02.021","volume":"55","author":"C Protzel","year":"2009","unstructured":"Protzel C, Alcaraz A, Horenblas S, Pizzocaro G, Zlotta A, Hakenberg OW (2009) Lymphadenectomy in the surgical management of penile cancer. Eur Urol 55(5):1075\u20131088","journal-title":"Eur Urol"},{"issue":"3","key":"5398_CR3","doi-asserted-by":"publisher","first-page":"486","DOI":"10.1016\/j.eururo.2013.02.037","volume":"64","author":"MM Stuiver","year":"2013","unstructured":"Stuiver MM, Djajadiningrat RS, Graafland NM, Vincent AD, Lucas C, Horenblas S (2013) Early wound complications after inguinal lymphadenectomy in penile cancer: a historical cohort study and risk-factor analysis. Eur Urol 64(3):486\u2013492","journal-title":"Eur Urol"},{"issue":"5","key":"5398_CR4","doi-asserted-by":"publisher","first-page":"458","DOI":"10.1080\/0284186X.2023.2206524","volume":"62","author":"D Glombik","year":"2023","unstructured":"Glombik D, Davidsson S, Sandin F, Lambe M, Carlsson J, Sundqvist P et al (2023) Penile cancer: long-term infectious and thromboembolic complications following lymph node dissection\u2014a population-based study (Sweden). Acta Oncol 62(5):458\u2013464","journal-title":"Acta Oncol"},{"key":"5398_CR5","doi-asserted-by":"publisher","DOI":"10.1007\/s11255-026-05231-z","author":"J Molsted","year":"2026","unstructured":"Molsted J, Als AB, Jensen JB, Aagaard M, Jakobsen JK (2026) Complications after sentinel node biopsy and inguinal lymph node dissection in penile cancer: a Danish national cohort study. Int Urol Nephrol. https:\/\/doi.org\/10.1007\/s11255-026-05231-z","journal-title":"Int Urol Nephrol."},{"issue":"9","key":"5398_CR6","doi-asserted-by":"publisher","first-page":"3567","DOI":"10.1007\/s11255-026-05121-4","volume":"58","author":"J Molsted","year":"2026","unstructured":"Molsted J, Als AB, Jensen JB, Aagaard M (2026Sep) Jakobsen JK (2026) Danish National Penile Cancer Database, DaPeCa-data: characteristics, management, and survival 2000\u20132025. Int Urol Nephrol 58(9):3567\u20133579. https:\/\/doi.org\/10.1007\/s11255-026-05121-4","journal-title":"Int Urol Nephrol"},{"issue":"2","key":"5398_CR7","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1111\/bju.12993","volume":"117","author":"P Kirrander","year":"2016","unstructured":"Kirrander P, Sherif A, Friedrich B, Lambe M, Hakansson U, Steering Committee of the Swedish National Penile Cancer R (2016) Swedish National Penile Cancer Register: incidence, tumour characteristics, management and survival. BJU Int 117(2):287\u2013292","journal-title":"BJU Int"},{"issue":"2","key":"5398_CR8","doi-asserted-by":"publisher","first-page":"426","DOI":"10.1002\/ijc.25355","volume":"128","author":"NM Graafland","year":"2011","unstructured":"Graafland NM, Verhoeven RHA, Coebergh JWW, Horenblas S (2011) Incidence trends and survival of penile squamous cell carcinoma in the Netherlands. Int J Cancer 128(2):426\u2013432","journal-title":"Int J Cancer"},{"issue":"5","key":"5398_CR9","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1016\/j.eururo.2004.11.018","volume":"47","author":"BK Kroon","year":"2005","unstructured":"Kroon BK, Horenblas S, Meinhardt W, van der Poel HG, Bex A, van Tinteren H et al (2005) Dynamic sentinel node biopsy in penile carcinoma: evaluation of 10 years experience. Eur Urol 47(5):601\u2013606 (discussion 6)","journal-title":"Eur Urol"},{"issue":"3","key":"5398_CR10","doi-asserted-by":"publisher","first-page":"816","DOI":"10.1097\/01.ju.0000154565.37397.4d","volume":"173","author":"BK Kroon","year":"2005","unstructured":"Kroon BK, Horenblas S, Lont AP, Tanis PJ, Gallee MP, Nieweg OE (2005) Patients with penile carcinoma benefit from immediate resection of clinically occult lymph node metastases. J Urol 173(3):816\u2013819","journal-title":"J Urol"},{"key":"5398_CR11","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2023.1069284","volume":"13","author":"S Ma","year":"2023","unstructured":"Ma S, Zhao J, Liu Z, Wu T, Wang S, Wu C et al (2023) Prophylactic inguinal lymphadenectomy for high-risk cN0 penile cancer: the optimal surgical timing. Front Oncol 13:1069284","journal-title":"Front Oncol"},{"key":"5398_CR12","doi-asserted-by":"publisher","DOI":"10.1053\/j.semnuclmed.2025.10.001","author":"CA Moen","year":"2025","unstructured":"Moen CA, Jakobsen JK (2025) Sentinel node mapping in penile cancer: an update on methods and pitfalls. Semin Nucl Med. https:\/\/doi.org\/10.1053\/j.semnuclmed.2025.10.001","journal-title":"Semin Nucl Med"},{"issue":"1","key":"5398_CR13","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1111\/bju.15678","volume":"130","author":"HM de Vries","year":"2022","unstructured":"de Vries HM, Lee HJ, Lam W, Djajadiningrat RS, Ottenhof SR, Roussel E et al (2022) Clinicopathological predictors of finding additional inguinal lymph node metastases in penile cancer patients after positive dynamic sentinel node biopsy: a European multicentre evaluation. BJU Int 130(1):126\u2013132","journal-title":"BJU Int"},{"issue":"3","key":"5398_CR14","doi-asserted-by":"publisher","first-page":"500","DOI":"10.1016\/j.euf.2022.11.018","volume":"9","author":"G Fallara","year":"2023","unstructured":"Fallara G, Pozzi E, Onur Cakir O, Tandogdu Z, Castiglione F, Salonia A et al (2023) Diagnostic accuracy of dynamic sentinel lymph node biopsy for penile cancer: a systematic review and meta-analysis. Eur Urol Focus 9(3):500\u2013512","journal-title":"Eur Urol Focus"},{"issue":"5","key":"5398_CR15","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1080\/21681805.2021.1882560","volume":"55","author":"JK Jakobsen","year":"2021","unstructured":"Jakobsen JK, Hoyer S, Bouchelouche K, Jensen JB (2021) DaPeCa-8: drawing the map of lymphatic drainage in patients with invasive penile cancer\u2014evidence from SPECT\/CT and sentinel node surgery. Scand J Urol 55(5):383\u2013387","journal-title":"Scand J Urol"},{"issue":"2","key":"5398_CR16","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1111\/bju.13127","volume":"117","author":"JK Jakobsen","year":"2016","unstructured":"Jakobsen JK, Krarup KP, Sommer P, Nerstrom H, Bakholdt V, Sorensen JA et al (2016) DaPeCa-1: diagnostic accuracy of sentinel lymph node biopsy in 222 patients with penile cancer at four tertiary referral centres\u2014a national study from Denmark. BJU Int 117(2):235\u2013243","journal-title":"BJU Int"},{"issue":"3 Pt B","key":"5398_CR17","first-page":"E48","volume":"111","author":"P Kirrander","year":"2013","unstructured":"Kirrander P, Andren O, Windahl T (2013) Dynamic sentinel node biopsy in penile cancer: initial experiences at a Swedish referral centre. BJU Int 111(3 Pt B):E48-53","journal-title":"BJU Int"},{"issue":"5","key":"5398_CR18","doi-asserted-by":"publisher","first-page":"943","DOI":"10.1590\/s1677-5538.ibju.2020.0959","volume":"47","author":"DS Zekan","year":"2021","unstructured":"Zekan DS, Dahman A, Hajiran AJ, Luchey AM, Chahoud J, Spiess PE (2021) Prognostic predictors of lymph node metastasis in penile cancer: a systematic review. Int Braz J Urol 47(5):943\u2013956","journal-title":"Int Braz J Urol"},{"issue":"1","key":"5398_CR19","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1111\/j.2517-6161.1996.tb02080.x","volume":"58","author":"R Tibshirani","year":"1996","unstructured":"Tibshirani R (1996) Regression shrinkage and selection via the lasso. J R Stat Soc Ser B Stat Methodol 58(1):267\u2013288","journal-title":"J R Stat Soc Ser B Stat Methodol"},{"issue":"1","key":"5398_CR20","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1093\/biomet\/73.1.13","volume":"73","author":"KY Liang","year":"1986","unstructured":"Liang KY, Zeger SL (1986) Longitudinal data-analysis using generalized linear-models. Biometrika 73(1):13\u201322","journal-title":"Biometrika"},{"issue":"2","key":"5398_CR21","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0169962","volume":"12","author":"H Bonsang-Kitzis","year":"2017","unstructured":"Bonsang-Kitzis H, Mouttet-Boizat D, Guillot E, Feron JG, Fourchotte V, Alran S et al (2017) Medico-economic impact of MSKCC non-sentinel node prediction nomogram for ER-positive HER2-negative breast cancers. PLoS ONE 12(2):e0169962","journal-title":"PLoS ONE"},{"key":"5398_CR22","doi-asserted-by":"publisher","DOI":"10.3390\/cancers16213638","author":"I Cebrecos","year":"2024","unstructured":"Cebrecos I, Torras I, Castillo H, Pumarola C, Ganau S, Sitges C et al (2024) Predicting additional metastases in axillary lymph node dissection after neoadjuvant chemotherapy: ratio of positive\/total sentinel nodes. Cancers (Basel). https:\/\/doi.org\/10.3390\/cancers16213638","journal-title":"Cancers (Basel)"},{"issue":"5","key":"5398_CR23","doi-asserted-by":"publisher","first-page":"742","DOI":"10.1016\/j.eururo.2010.08.015","volume":"58","author":"NM Graafland","year":"2010","unstructured":"Graafland NM, Lam W, Leijte JA, Yap T, Gallee MP, Corbishley C et al (2010) Prognostic factors for occult inguinal lymph node involvement in penile carcinoma and assessment of the high-risk EAU subgroup: a two-institution analysis of 342 clinically node-negative patients. Eur Urol 58(5):742\u2013747","journal-title":"Eur Urol"},{"issue":"1","key":"5398_CR24","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1016\/S0022-5347(06)00500-3","volume":"176","author":"BK Kroon","year":"2006","unstructured":"Kroon BK, Nieweg OE, van Boven H, Horenblas S (2006) Size of metastasis in the sentinel node predicts additional nodal involvement in penile carcinoma. J Urol 176(1):105\u2013108","journal-title":"J Urol"}],"container-title":["International Urology and Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11255-026-05398-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11255-026-05398-5","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11255-026-05398-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T03:15:53Z","timestamp":1789787753000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11255-026-05398-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,19]]},"references-count":24,"alternative-id":["5398"],"URL":"https:\/\/doi.org\/10.1007\/s11255-026-05398-5","relation":{},"ISSN":["1573-2584"],"issn-type":[{"value":"1573-2584","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,19]]},"assertion":[{"value":"10 April 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 September 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 September 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}}]}}