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Single-port Non-liposuction Endoscopic Axillary Lymph Node Dissection in Breast Cancer Surgery
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Virtual lymph node analysis to evaluate axillary lymph node coverage provided by tangential breast irradiation.

Shin-Hyung Park1, Jae-Chul Kim1, Jeong Eun Lee1

  • 1Department of Radiation Oncology, Kyungpook National University Hospital, Daegu, Korea.

Radiation Oncology Journal
|April 16, 2015
PubMed
Summary

Tangential breast irradiation inadequately covers axillary lymph nodes (LNs), especially in level II. Individualized radiation fields are needed for effective axillary LN treatment, particularly for patients with smaller breast volumes or lower body mass index (BMI).

Keywords:
AxillaBreast neoplasmLymph nodesRadiotherapy

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Area of Science:

  • Radiation Oncology
  • Medical Imaging
  • Surgical Oncology

Background:

  • Axillary lymph node (LN) involvement is a critical prognostic factor in breast cancer.
  • Accurate radiation field coverage is essential for effective treatment and reducing recurrence.
  • Current tangential breast irradiation techniques may not adequately cover all axillary regions.

Purpose of the Study:

  • To evaluate the coverage of axillary lymph nodes (LNs) by tangential breast irradiation fields.
  • To compare standard contouring methods with virtual LN analysis using FDG-PET/CT.
  • To identify factors influencing axillary LN coverage.

Main Methods:

  • Analysis of 48 women treated with whole breast irradiation post-breast-conserving surgery.
  • Delineation of axillary and breast volumes using RTOG contouring atlas.
  • Generation of virtual LN contours by fusing FDG-PET/CT with CT scans.

Main Results:

  • Median coverage of level I and II axillary volumes by the 95% isodose line was 33.5% and 0.6%, respectively.
  • 84.6% of virtual LNs in level I were covered, but none in level II.
  • Coverage was associated with body mass index (BMI) and breast volume, with reduced coverage in smaller breasts or lower BMI.

Conclusions:

  • Tangential breast irradiation provides insufficient dose to axillary regions, particularly level II.
  • Individualized, anatomy-based radiation fields are necessary for optimal axillary LN irradiation.
  • Patient-specific factors like BMI and breast volume impact radiation coverage.