{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T03:27:05Z","timestamp":1773890825845,"version":"3.50.1"},"reference-count":16,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,5,18]],"date-time":"2022-05-18T00:00:00Z","timestamp":1652832000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:p>Penile squamous cell carcinoma (SCC) is a rare malignancy, which is known to invade local inguinal lymph nodes prior to progressing to the pelvis. Dynamic sentinel lymph node biopsy (DSLNB) is a standard for the minimally invasive assessment of lymphadenopathy in patients with subclinical groin metastasis. Hybrid <jats:sup>99m<\/jats:sup>Tc Single-Photon Emission Computed Tomography (SPECT-CT) has been shown to increase the accuracy of identifying first draining \u201csentinel\u201d nodes (SN). Unilateral inguinal visualization on SPECT-CT is a rare presentation, which may increase the likelihood of a false negative SN biopsy. Retrospective analysis from three-penile cancer uro-oncologists in Melbourne, Australia identified 78 groins undergoing DSLNB for intermediate\/high risk primary disease. Unilateral SPECT-CT results were observed in four patients suggesting a functional pattern of lymph diversion. Analysis confirmed malignancy (<jats:italic>n<\/jats:italic> = 2), sarcoidosis (<jats:italic>n<\/jats:italic> = 1), and evidence of local inflammation in SPECT-CT negative groins. Findings re-iterate the role of SPECT-CT a pre-operative adjunct. Experienced multimodal groin assessment using palpation, SPECT-CT, lymphoscintigraphy, and blue dye tracking remains paramount. Unilateral SN on pre-operative SPECT-CT in men with intermediate\/high-risk penile SCC should elicit a higher degree of clinical suspicion. We recommend a low threshold for recommending radical inguinal lymph node dissection (ILND) for groins refractory to minimally invasive assessment.<\/jats:p>","DOI":"10.3389\/fsurg.2022.882011","type":"journal-article","created":{"date-parts":[[2022,5,18]],"date-time":"2022-05-18T05:51:28Z","timestamp":1652853088000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Interrogating the Impassable: A Case Series and Literature Review of Unilateral SPECT-CT Groin Visualization in Men With Penile Cancer"],"prefix":"10.3389","volume":"9","author":[{"given":"Jonathan S.","family":"O'Brien","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiasian","family":"Teh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian D.","family":"Kelly","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenneth","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Todd","family":"Manning","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marc","family":"Furrer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justin","family":"Chee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nathan","family":"Lawrentschuk","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,5,18]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"394","DOI":"10.3322\/caac.21492","article-title":"Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"68","author":"Bray","year":"2018","journal-title":"Ca Cancer J Clin."},{"key":"B2","unstructured":"EAU\n            HakenbergOW\n            Comp\u00e9ratE\n            MinhasS\n            NecchiA\n            ProtzelC\n            WatkinN\n          Guidelines on penile cancer 2022.2022"},{"key":"B3","unstructured":"Early wound complications after inguinal lymphadenectomy in penile cancer: a historical cohort study and risk-factor analysis48692\n            StuiverMM\n            DjajadiningratRS\n            GraaflandNM\n            VincentAD\n            LucasC\n            HorenblasS\n          10.1016\/j.eururo.2013.02.03723490726Eur Urol.642013"},{"key":"B4","doi-asserted-by":"publisher","first-page":"742","DOI":"10.1016\/j.eururo.2010.08.015","article-title":"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","volume":"58","author":"Graafland","year":"2010","journal-title":"Eur Urol."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1176","DOI":"10.1007\/s00259-017-3636-1","article-title":"Investigating the role of SPECT\/CT in dynamic sentinel lymph node biopsy for penile cancers","volume":"44","author":"Saad","year":"2017","journal-title":"Eur J Nucl Med Mol I."},{"key":"B6","doi-asserted-by":"publisher","first-page":"364","DOI":"10.2967\/jnumed.108.059733","article-title":"van der, Olmos RA, Nieweg OE, Horenblas S. 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