Table 2.

Summary of methodological aspects and recommendations of the EAU-ASCO, ESMO-EURACAN, and NCCN guidelines on LN management in PC

Node stage and risk	ESMO-EURECAN	NCCN	EAU-ASCO
cN evaluation	Palpability	Palpability, number, unilateral/bilateral, dimensions, ± mobility MRI if difficult to assess	Palpability, number, unilateral/bilateral, dimensions, ± mobility
cN0 classification criteria	pT stage, grade, LVI	pT stage, grade, LVI, PNI	pT stage, grade, LVI, PNI
Low risk cN0 management	Surveillance (pTa/pTis and pT1G1) (III, A)	Surveillance (PeIN, Ta, T1a)	Surveillance (pTa, pTis and negative LVI pT1)
Intermediate risk cN0 management	DSNB (pT1G2) If not available Modified ILND ± frozen section (III, A)	modified or radical ILND or DSNB (T1b, G1–2)	surveillance vs DSNB/ILND (T1a G2 disease) (weak)
High risk cN0 management	DSNB (pT1-4G3/G4 or LVI+) (III, A) If not available Modified ILND ± frozen section (III, A)	Modified or radical ILND or DSNB (T1b, G3–4; T2 or greater)	DSNB/ILND (T1b or higher) (strong)
cN1 management	Modified ILND	FNA, with or without excisional biopsy Risk features (RF): T1, G3, LVI+; PNI+; low differentiation (> 50%)  RF+: ILVD  RF−: Percutaneous lymph node biopsy   Biopsy-:   Bilateral ILVD   Neoadjuvant chemotherapy + ILVD   Biopsy+:   Strict surveillance   Excisional biopsy	FNA, with or without excisional biopsy + 18FDG-PET/CT or CT (SE: strong) Open ILND (LE 2A; SE strong) fsILND (LE 2B)

EAU-ASCO European Association of Urology-American Society of Clinical Oncology, ESMO-EURACAN European Society for Medical Oncology-European Reference Network on Rare Adult Solid Cancers, NCCN National Comprehensive Cancer Network, LN lymph node, PC penile cancer, LoE level of evidence, GRADE Grading of Recommendations, Assessment, Development, and Evaluations, cN clinical nodal status, MRI magnetic resonance imaging, LVI lymphovascular invasion, PNI perineural invasion, DSNB dynamic sentinel node biopsy, ILND inguinal lymph node dissection, ILVD inguinal lymphadenectomy