Testo Vitality again if they're positive finding a little aspiration is recommended followed by further except by excisional biopsy if if need be and then treatment with inguinal lymph node dissection when it comes to managing high-risk patients with non palpable and non palpable lymph nodes first it's important to identify the criteria for high-risk patients those are patients who are clinical stage T two or greater and there are tumor shows 50% that has greater than 50% poorly differentiated disease and friends and then there's lympho vascular invasion present and these are generally treated with bilateral pelvic England limb or sorry bilateral superficial England own lymph node dissection plus or minus deep and going to lymph node dissection if there are positive lymph nodes in the superficial area again bilateral dynamic sentinel lymph node biopsy is less commonly done because not a lot of centers do it but it is an acceptable mode of treatment or approach and it it is important to emphasize that delaying a treatment and/or delaying a lymphatic

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