Internal mammary lymph node inclusion in standard tangent breast fields: effects of body habitus

The purpose of this study was to determine the variability of internal mammary node (IMN) coverage with standard breast tangent fields using surface anatomy as determined by computed tomography (CT) planning for patients treated with either breast-conserving treatment or postmastectomy, and to evaluate the influence of body habitus and shape on IMN coverage with standard tangent fields. This prospective study included consecutive women with breast cancer who underwent either local excision or mastectomy and had standard tangent fields intended to cover the breast plus a margin simulated using surface anatomy. CT planning determined the location of the IMN with respect to the tangent fields designed from surface anatomy. The internal mammary vessels were used as surrogates for the IMNs. CT measurements of the presternal fat thickness and anteroposterior (AP) and transverse skeletal diameters were made to determine their relationship to the inclusion of IMNs within the tangent fields. Only seven patients (14%) had their IMNs completely within the tangent fields. Twenty patients (40%) had partial coverage of their IMNs, and 23 (46%) had their IMNs completely outside the fields. IMN inclusion was inversely correlated with presternal fat thickness. Thoracic skeletal shape was not associated with IMN inclusion. Standard tangent fields generally do not cover the IMNs completely but may cover them at least partially in a majority of patients. The presternal fat thickness is inversely correlated with IMN inclusion in the tangent fields.