Kaplan W D, Andersen J W, Siddon R L, Connolly B T, McCormick C A, Laffin S M, Rosenbaum E M, Jennings C A, Recht A, Harris J R
Joint Program in Nuclear Medicine, Harvard Medical School, Boston, Massachusetts.
J Nucl Med. 1988 Apr;29(4):473-8.
In breast cancer patients, radiation therapy planning must account for individual anatomy to ensure optimal coverage of tumor and internal mammary nodes. To achieve this, three-dimensional radionuclide lymphoscintigraphy (RNLS) was performed in 167 patients by obtaining two images of the nodes using a 30-degree slant hole collimator rotated 180 degrees between images. Analysis of 768 nodes (mean 4.6/patient) visualized from the level of rib 1 through interspace 5 was performed. The number of nodes seen was not a function of patient age. Cross-communication to the contralateral node chain occurred in 13.8% of cases. Eighty-two percent of nodes were located near the first three ribs and interspaces; 23% were located beyond 3.0 cm from the mid-sternal line. At the level of the radiation beam match line (second rib or interspace), 4.5% of nodes were deeper than 3.0 cm. From rib 3 through interspace 5, 3.9% were deeper than 3.0 cm. Using an idealized tangential field, at least one node would have been missed in 16.2% of patients. Three-dimensional RNLS allows definition and localization of normal sized nodes and ensures that radiation therapy portals can be tailored for each individual under treatment.
在乳腺癌患者中，放射治疗计划必须考虑个体解剖结构，以确保肿瘤和内乳淋巴结得到最佳覆盖。为实现这一目标，对167例患者进行了三维放射性核素淋巴闪烁显像（RNLS），通过使用30度斜孔准直器获取淋巴结的两张图像，在图像之间将准直器旋转180度。对从第1肋水平至第5肋间可见的768个淋巴结（平均每位患者4.6个）进行了分析。所见淋巴结数量与患者年龄无关。13.8%的病例出现了与对侧淋巴结链的交叉交通。82%的淋巴结位于前三根肋骨和肋间附近；23%位于距胸骨中线3.0 cm以外。在放射线束匹配线（第2肋或肋间）水平，4.5%的淋巴结深度超过3.0 cm。从第3肋至第5肋间，3.9%的淋巴结深度超过3.0 cm。使用理想化的切线野，16.2%的患者至少会遗漏一个淋巴结。三维RNLS能够确定正常大小淋巴结的位置，并确保可为每位接受治疗的个体量身定制放射治疗野。
