阴茎癌腹股沟淋巴结转移的诊断：现状与进展

Diagnosis of Inguinal Lymph Node Metastasis in Penile Cancer: Current Status and Progress

摘要: 阴茎癌虽相对罕见但侵袭性强，腹股沟淋巴结转移是其最主要的转移途径与独立预后因素。准确判断淋巴结状态直接影响分期决策、治疗策略及生存结局。本文系统综述阴茎癌腹股沟淋巴结转移的诊断现状与技术进展，聚焦从初筛至确诊的多层级评估体系。临床触诊作为基础筛查手段，简便易行但对微转移漏诊率高；影像学检查已形成分层评估路径：超声凭借高分辨率成为首选筛查工具，CT与PET-CT在全身分期及远处转移排查中发挥核心作用，MRI则以优异软组织显像能力在微小结构评估中独具价值。在病理确诊层面，超声引导细针穿刺活检有效衔接影像与病理诊断，动态前哨淋巴结活检已成为临床淋巴结阴性患者的标准分期术式，在保障诊断准确性的同时显著降低手术并发症。分子生物学检测正逐步从辅助工具向风险分层补充手段演进，p53、p16INK4a、PD-L1等标志物及流式细胞术、二代测序等技术在微灶检测与疑难病例鉴别中展现出潜力。当前，“无创筛查–精准影像–病理确诊–分子补充”的阶梯式协同诊断模式已基本形成，但仍面临微小转移灶检出敏感度不足、动态前哨淋巴结活检假阴性率波动、分子检测缺乏标准化及资源分布不均等挑战。未来，推动多模态技术融合、人工智能辅助判读、液体活检联合应用及低成本适宜技术研发，将成为实现阴茎癌腹股沟淋巴结“精准化、微创化、个体化”诊断的重要方向。

Abstract: Although penile carcinoma is relatively rare, it is highly invasive, and inguinal lymph node metastasis is the most important metastasis route and an independent prognostic factor. Accurate judgment of lymph node status directly affects staging decision, treatment strategy and survival outcome. This paper systematically reviews the diagnosis status and technical progress of inguinal lymph node metastasis of penile cancer, focusing on the multi-level evaluation system from primary screening to diagnosis. As a basic screening method, clinical palpation is simple and easy, but the missed diagnosis rate of micrometastasis is high. Imaging examination has formed a hierarchical evaluation path: ultrasound has become the first choice screening tool because of its high resolution, CT and PET-CT play a core role in the whole body staging and distant metastasis investigation, and MRI has unique value in the evaluation of micro-structures because of its excellent soft tissue imaging ability. At the level of pathological diagnosis, ultrasound-guided fine needle biopsy effectively connects the image with pathological diagnosis, and dynamic sentinel lymph node biopsy has become the standard staging operation for patients with negative lymph nodes, which can ensure the accuracy of diagnosis and significantly reduce surgical complications. Molecular biological detection is gradually evolving from an auxiliary tool to a risk stratification supplementary means. Markers such as p53, p16INK4a and PD-L1, as well as technologies such as flow cytometry and second-generation sequencing, have shown potential in micro-focus detection and difficult case identification. At present, the step-by-step collaborative diagnosis model of “non-invasive screening-accurate imaging-pathological diagnosis-molecular supplement” has basically taken shape, but it still faces challenges such as insufficient sensitivity in detecting micrometastases, fluctuation of false negative rate of dynamic sentinel lymph node biopsy, lack of standardization of molecular detection and uneven distribution of resources. In the future, promoting the integration of multimodal technology, artificial intelligence-assisted interpretation, combined application of liquid biopsy and low-cost research and development of appropriate technologies will become an important direction to realize the “accurate, minimally invasive and individualized” diagnosis of inguinal lymph nodes in penile cancer.