Extramammary Paget's Disease With Bilateral Sentinel Lymph Node Biopsy: a Multicenter Study of Lymphatic Patterns and Outcomes.

IF 2.8 4区医学 Q1 DERMATOLOGY

Clinical and Experimental Dermatology Pub Date : 2026-10-17 DOI:10.1093/ced/llag436

Yoshiki Sakai, Eiji Nakano, Ken Horisaki, Shoichiro Mori, Yuta Kage, Dai Ogata, Shusuke Yoshikawa, Masashi Akiyama, Naoya Yamazaki, Kenjiro Namikawa

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引用次数: 0

Abstract

Background: Extramammary Paget's disease (EMPD) can metastasize to lymph nodes or distant sites. Sentinel lymph node biopsy (SLNB) is recommended for invasive EMPD without clinical nodal involvement.

Objectives: Lesions near or across the midline may show bilateral lymphatic drainage, but the clinical significance of bilateral SLNB remains unclear. This study evaluated SLN metastatic distribution and its association with clinicopathological features, lymphatic drainage patterns, and survival in patients undergoing bilateral SLNB.

Methods: We retrospectively reviewed 147 patients with EMPD who underwent bilateral SLNB at three institutions between 2015 and 2025. Tumor characteristics, SLN status, recurrence, and survival outcomes were analyzed. Patients were stratified as bilateral negative, unilateral positive, or bilateral positive. Clinicopathological features, lymphatic drainage patterns, and survival outcomes, including overall survival (OS), recurrence-free survival (RFS), and disease-free survival (DFS), were compared.

Results: Bilateral SLN positivity was detected in eight male patients with genital nodular lesions; unilateral positivity occurred in 12 patients, and 127 were bilaterally negative. Contralateral SLNs were frequently negative despite lesions crossing the midline, although bilateral metastases developed in two patients. Four ectopic lower abdominal lesions were identified, two with irregular drainage. Patients with bilaterally negative SLNs had significantly better survival than those with SLN metastases. No significant differences in RFS or DFS were observed between the unilateral- and bilateral-positive groups.

Conclusions: Bilateral SLN positivity is rare and limited to male genital cases. It was not associated with worse disease-related outcomes than unilateral positivity. Risk of bilateral metastasis appears to depend more on tumor location than intrinsic aggressiveness.

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双侧前哨淋巴结活检的乳腺外佩吉特病：淋巴模式和结果的多中心研究

背景：乳腺外佩吉特病（EMPD）可转移到淋巴结或远处部位。前哨淋巴结活检（SLNB）推荐浸润性EMPD没有临床淋巴结累及。目的：中线附近或中线两侧病变可出现双侧淋巴引流，但双侧SLNB的临床意义尚不清楚。本研究评估了双侧SLNB患者的SLN转移分布及其与临床病理特征、淋巴引流模式和生存的关系。方法：我们回顾性分析了2015年至2025年间在三家机构接受双侧SLNB治疗的147例EMPD患者。分析肿瘤特征、SLN状态、复发和生存结果。患者分为双侧阴性、单侧阳性和双侧阳性。比较临床病理特征、淋巴引流模式和生存结果，包括总生存期（OS）、无复发生存期（RFS）和无病生存期（DFS）。结果：8例男性生殖器结节性病变中均检出双侧SLN阳性；单侧阳性12例，双侧阴性127例。尽管病变跨越中线，但对侧sln经常呈阴性，尽管有两例患者出现双侧转移。发现4个下腹异位病变，2个伴有不规则引流。双侧SLN阴性患者的生存率明显高于SLN转移患者。单侧阳性组和双侧阳性组的RFS和DFS无显著差异。结论：双侧SLN阳性是罕见的，仅限于男性生殖器病例。与单侧阳性相比，与疾病相关的结果并不差。双侧转移的风险似乎更多地取决于肿瘤的位置而不是内在的侵袭性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical and Experimental Dermatology 医学-皮肤病学

CiteScore

3.20

自引率

2.40%

发文量

389

审稿时长

3-8 weeks

期刊介绍： Clinical and Experimental Dermatology (CED) is a unique provider of relevant and educational material for practising clinicians and dermatological researchers. We support continuing professional development (CPD) of dermatology specialists to advance the understanding, management and treatment of skin disease in order to improve patient outcomes.