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Accuracy of internal mammary lymph node localization using lymphoscintigraphy, sonography and CT
Anne E Saarnak1, Coen W Hurkmans, Bradley R Pieters
1Department of Radiotherapy, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
Summary
Accurate internal mammary (IM) lymph node localization is crucial for breast cancer radiotherapy. Lymphoscintigraphy and CT scans offer acceptable measurement accuracy for IM node detection, unlike sonography.
Area of Science:
- Medical Imaging
- Radiation Oncology
- Breast Cancer Treatment
Background:
- Accurate localization of internal mammary (IM) lymph nodes is essential for effective breast cancer radiotherapy.
- Current localization techniques require precise measurement of IM lymph node depth and lateral position.
Purpose of the Study:
- To evaluate the measurement accuracy of three techniques for direct or indirect localization of internal mammary lymph nodes.
- To compare the accuracy of lymphoscintigraphy, sonography, and CT for IM lymph node and vessel localization.
Main Methods:
- 40 patients underwent lymphoscintigraphy for IM lymph node depth and lateral distance measurement.
- Sonography and CT were used to measure the position of IM vessels in intercostal spaces 1-4.
- A mathematical model analyzed lymphoscintigraphy and CT data for node detection accuracy.
Main Results:
- Sonography demonstrated systematic errors in vessel depth and inaccurate lateral positioning.
- Lymphoscintigraphy achieved a measurement accuracy of 5 mm depth and 6 mm lateral for node detection.
- CT provided an accuracy of 6 mm depth and 7 mm lateral for indirect node detection.
Conclusions:
- Sonography is unsuitable for IM vessel or node position measurement.
- Lymphoscintigraphy and CT offer acceptable measurement accuracies for IM lymph node detection in radiotherapy planning.