Department of Radiation Oncology, Klinikum rechts der Isar, Technical University, Munich, Germany.
Department of Radiation Oncology, Klinikum rechts der Isar, Technical University, Munich, Germany; Faculty of Medicine, Technical University, Munich, Germany.
Int J Radiat Oncol Biol Phys. 2019 Mar 1;103(3):574-582. doi: 10.1016/j.ijrobp.2018.07.2025. Epub 2018 Aug 14.
The aim of this study was to localize locoregional lymph node metastases using positron emission tomography with fluorine 18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) data sets in a large cohort of patients and to evaluate the existing Radiation Therapy Oncology Group (RTOG) clinical target volume (CTV) and the European Society for Radiation Therapy & Oncology (ESTRO) CTV contouring guidelines.
A total of 235 patients with 580 FDG/PET-CT positive locoregional lymph node metastases were included in our analysis. The patients were divided into 4 groups according to their course of disease (primary vs recurrent breast cancer) and the presence or absence of distant metastasis at the time of the FDG-PET/CT staging (distant metastasis vs no distant metastasis). All imaging data were imported into the planning system, and each lymph node was manually contoured. A patient with "standard anatomy" was chosen as a template, and all contoured structures were registered rigidly and nonrigidly to this patient. A comprehensive 3-dimensional atlas was created, including all identified lymph node metastases. The incidences of lymph node metastases were analyzed and are presented with color coding in the atlas. Lymph node levels (axillary, internal mammary, supraclavicular) were contoured according to RTOG and ESTRO guidelines and evaluated.
The mean volume of the lymph nodes was 1.7 ± 2.6 cm with an average diameter of 1.3 ± 0.7 cm. Most lymph nodes were in level I (n = 316; 54.5%) followed by the supraclavicular region (n = 80; 13.8%), level II (n = 57; 9.8%), level III (n = 58; 10.0%), and the internal mammary region (n = 55; 9.5%). The covered lymph node volume was 69.8% ± 35.5% (69.1% ± 36.3%) for primary breast cancer and 57.6% ± 38.9% (51.1% ± 39.1%) for recurrent breast cancer using the RTOG (ESTRO) guidelines. The internal mammary region and supraclavicular region were affected more often in recurrent breast cancer compared with primary breast cancer. The occurrence of lymph node metastases outside the RTOG and ESTRO margins in patients with and without distant metastases was similar. The largest geometric deviations between RTOG/ESTRO CTV contours and lymph node occurrence were measured in the supraclavicular region, the internal mammary region, and level II.
The provided lymph node atlas illustrates where lymph node metastases occur in different clinical situations and presents areas at high risk (ie "hot spots" of lymph node metastases).
本研究旨在通过氟 18-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDG-PET/CT）数据集对大量患者进行局部区域淋巴结转移的定位，并评估现有的放射治疗肿瘤学组（RTOG）临床靶区（CTV）和欧洲放射治疗与肿瘤学学会（ESTRO）CTV 勾画指南。
我们的分析共纳入了 235 名 580 例 FDG/PET-CT 阳性局部区域淋巴结转移患者。根据疾病进程（原发性 vs 复发性乳腺癌）和 FDG-PET/CT 分期时是否存在远处转移（远处转移 vs 无远处转移）将患者分为 4 组。所有影像数据均被导入至规划系统，并手动勾画每个淋巴结。选择一名具有“标准解剖结构”的患者作为模板，并将所有勾画的结构刚性和非刚性地注册到该患者。创建了一个全面的三维图谱，其中包含所有确定的淋巴结转移。对淋巴结转移的发生率进行了分析，并在图谱中用颜色编码进行了呈现。根据 RTOG 和 ESTRO 指南对腋窝、内乳、锁骨上淋巴结水平进行了勾画和评估。
淋巴结的平均体积为 1.7±2.6cm，平均直径为 1.3±0.7cm。大多数淋巴结位于 I 水平（n=316；54.5%），其次是锁骨上区域（n=80；13.8%）、II 水平（n=57；9.8%）、III 水平（n=58；10.0%）和内乳区域（n=55；9.5%）。使用 RTOG（ESTRO）指南，原发性乳腺癌的覆盖淋巴结体积为 69.8%±35.5%（69.1%±36.3%），复发性乳腺癌为 57.6%±38.9%（51.1%±39.1%）。与原发性乳腺癌相比，复发性乳腺癌更常累及内乳区和锁骨上区。有远处转移和无远处转移的患者的 RTOG 和 ESTRO 边界外淋巴结转移的发生率相似。在 RTOG/ESTRO CTV 轮廓和淋巴结出现之间测量到最大的几何偏差位于锁骨上区、内乳区和 II 水平。
提供的淋巴结图谱说明了在不同临床情况下淋巴结转移的位置，并呈现了高风险区域（即淋巴结转移的“热点”）。
