Assessment of Lymph Vessel Density (LVD) and Lympho-Vascular Invasion (LVI) in Squamous Cell Carcinoma (SCC) of the Penis Using D2-40 and P53 Immunostaining and Correlation of These Markers With Lymph Node Metastasis

1. Background The use of D-240 and p53 as a prognosticmarkers to predict early lymph node metastasis in amputed specimens of penis so as to avoid unnecessary lymphadenectomy. Aim To detect early metastasis in amputed specimens of penis, by using two immuno markers, D2-40 and p53 and correlation of these with the histopathological variables and clinical stage. Also to compare which marker is the better predictor for metastasis. Materials and Methods Retrospective study of 49 cases of partial /total amputation with lymphadenectomy of penile cancers were divided into metastatic and non metastatic groups on H& E sections in which 16/49 had metastasis Histological slides from all cases were processed with immunohistochemical technique using antip53 and antiD2-40 antibodies. The p53 tumor density was calculated in 100 cells with 20 % cut off and was graded as positive when more than 20 % of the tumor cells with positive nuclear staining. For D2-40, LVD was calculated in the peritumoral and normal area by taking 10 % cutoff of positive staining of lymphatic cells within the lymphatics. All the pathological and clinical variables were calculated by Chi square test. Results 13 /49 cases showed increased p53 tumor density and 11/49 showed increased LVD by D2-40. pvalue of 0.05 was considerd significant in our study. Both the markers did not correlate statistically with histopathological and clinical variables like phimosis, BXO, clinical node status, tumor type, tumor grade, depth of invasion, LVI. Both had low positive predictive value. Therefore in our study p53 and D2-40 cannot predict the early lymph node metastasis because of low positive predictive value, even though they are sensitive. Conclusions Both the markers had low specificity and low positive predictive value, which suggest that they are not able to predict lymph node metastasis even though they are sensitive and therefore they are not helpful to decide for prophylactic lymphadenectomy. D2-40 can be used as a good adjunct along with H& E sections on the initial amputated specimens to detect the definite LVI which needs to be confirmed by D2-40 staining in difficult and doubtful situations, on routine histology.