Title : Feasibility and outcomes of palpation-guided inguinal node sampling with frozen section in penile cancer: An affordable staging strategy in a resource-limited setting
Abstract:
Background: In low-resource centres, advanced nodal staging techniques such as dynamic sentinel lymph node biopsy are often unavailable, leading to under-staging or overtreatment in penile cancer. Palpation-guided inguinal node sampling with intraoperative frozen section offers a cost-effective alternative for early detection of nodal metastases and guides timely therapeutic lymphadenectomy.
Methods: Between January 2022 and December 2024, 25 patients with biopsy-proven penile squamous cell carcinoma (cN0 or cN1) underwent primary tumour surgery (partial/total penectomy or wide local excision) with concurrent palpation-guided inguinal node sampling. Intraoperative frozen section was performed where available; positive results prompted immediate ipsilateral modified inguinal lymphadenectomy. Patients were followed for a median of 20 months for recurrence, survival, and postoperative complications.
Results: Metastatic nodes were detected in 8/25 patients (32%). Immediate lymphadenectomy was performed in 7 of these patients, avoiding a second surgery. Node sampling complication rate was 8%, mainly minor wound infections. Two-year inguinal recurrence-free survival was 84%, and cancer-specific survival was 80%. This approach avoided unnecessary full lymphadenectomy in 17 patients (68%), significantly reducing morbidity and inpatient stay compared with historical controls.
Conclusions: In centres without nuclear medicine or mapping facilities, palpation-guided inguinal node sampling with frozen section is a feasible, affordable, and oncologically safe staging method in penile cancer. Wider adoption of this technique could optimise surgical decision-making, reduce overtreatment, and conserve healthcare resources without compromising survival outcomes.
Keywords: Penile cancer, inguinal node sampling, frozen section, low-cost staging, resource-limited setting.
