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Atlas of sentinel lymph nodes in early breast cancer using single-photon emission computed tomography: implication for lymphatic contouring - PubMed

Atlas of sentinel lymph nodes in early breast cancer using single-photon emission computed tomography: implication for lymphatic contouring

Sergey Nikolaevich Novikov et al. Radiat Oncol J. 2021 Mar.

Abstract

Purpose: to determine the localization of sentinel lymph nodes (SLNs) in a large cohort of patients with breast cancer and validate the European Society for Therapeutic Radiology and Oncology (ESTRO), Radiation Therapy Oncology Group (RTOG), and Radiotherapy Comparative Effectiveness (RADCOMP) guidelines on regional lymph node clinical target volume (CTV-LN) delineation.

Materials and methods: A total of 254 women with cT1-3N0-1M0 breast cancer underwent single-photon emission computed tomography (SPECT-CT) visualization of SLNs after intra- and peritumoral injection of 99mTc-radiocolloids. All SPECT-CT images were fused with reference simulation computed tomography. A 3D atlas of SLNs was created and used for evaluation of CTV-LN defined by contouring guidelines.

Results: SPECT-CT visualized 532 SLNs that were localized in axillary level I in 67.5%, level II in 15.4%, level III in 7.3%, internal mammary in 8.5%, and supraclavicular in 1.3% cases. The majority of level II-IV and internal mammary SLNs were inside the recommended CTV-LN. Axillary level I SLNs were covered by ESTRO and RTOG contours in 85% and 85% cases, respectively. "Out of contours" SLNs were mostly detected in lateral subgroup of level I LN (18.5%), while 98%-99% of anterior pectoral and central axillary SLNs were covered by CTV-LN. Internal mammary SLNs were visualized in 33 cases and were outside ESTRO and RTOG contours in 3 and 6 observations, respectively.

Conclusion: SPECT-CT atlas of SLNs demonstrated that in most cases ESTRO and RTOG guidelines correctly represented CTV-LNs with the exception of lateral subgroup of SLNs.

Keywords: Breast cancer; Lymph nodes; Sentinel lymph nodes; Target volume delineation.

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Conflict of interest statement

Conflict of Interest

No potential conflict of interest was reported by the authors.

Figures

Fig. 1.
Fig. 1.

Lateral subgroup of axillary lymph nodes (blue) that are mostly out and partly inside the RTOG and the ESTRO contours. (A) Axial image represent lateral (blue), central (red), and anterior pectoral (green) subgroups of axillary lymph nodes in relation to ESTRO contours (green) and RTOG contours (yellow). (B) Coronal image of left lateral axillary lymph nodes. (C) Coronal image of right lateral axillary lymph nodes. ESRTO, European Society for Radiation Therapy and Oncology; RTOG, Radiation Therapy Oncology Group.

Fig. 2.
Fig. 2.

Localization of the supraclavicular lymph nodes (blue) with uptake of radiocolloids with regard to the European Society for Radiation Therapy and Oncology contours (green) and the Radiation Therapy Oncology Group contours (yellow).

Fig. 3.
Fig. 3.

Axial images of the left axillary lymph nodes. Yellow line represents the plan that connects the anterior-lateral surface of the II–V ribs and anterior surface of latissimus dorsi muscle. All anterior pectoral (green) and central (red) axillary lymph nodes are visualized anterior to this plan. (A) On the level of the II rib. (B) On the level of the III rib. (C) On the level the V rib.

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