FDG/PET-CT–Based Lymph Node Atlas in Breast Cancer Patients

Image Guided Evolution of Nodal Contouring Guidelines in Breast Cancer

“…One hundred fifty-three patients had isolated regional nodal recurrences, with a total of 243 lymph nodes mapped. Similar to the manuscript from Borm et al, 6 in this study the RTOG/ ESTRO guidelines encompassed the majority of the nodal metastases, but a significant number of recurrences occurred in other regions. Notable were recurrences in the supraclavicular region, specifically the lateral and posterior aspects of the area, which is consistent with the findings of other smaller studies.…”

“…The first study, by Borm et al, 6 uses fluorodeoxyglucose/ positron emission tomography-computed tomography (FDG/PET-CT) imaging from a large cohort of patients with breast cancer to identify locoregional lymph node metastasis at the time of their initial diagnosis or at the time of recurrence. 6 Sites of nodal metastasis at diagnosis or recurrence from over 1300 patients with breast cancer imaged with FDG/PET-CT from their institution were examined from 2010 to 2017, and 235 patients had 580 FDG/PET-CTepositive metastasis in the axillary, supraclavicular, and/or internal mammary nodal regions. Using rigid and nonrigid (deformable) image registration, the sites of metastasis were mapped to a template CT of a standard patient.…”

“…It should be noted that no information on the treatment(s) previously received by those with recurrent disease was available in this study. 6 The other recent study, from DeSelm et al, 7 also used 3-dimensional imaging to assess the distribution of locoregional nodal metastasis with respect to the published contouring guidelines 7 , but focused on recurrences alone. They assessed over 13,000 patients with breast cancer at their center between 1998 and 2013, comparing the locations of nodal recurrences identified with magnetic resonance imaging or CT with or without FDG/PET-CT to the RTOG and ESTRO breast cancer nodal atlases.…”

“…How do the new studies by Borm et al 6 and DeSelm et al 7 add to our knowledge of nodal patterns of spread in breast cancer? These studies have applied imaging modalities that provide higher sensitivity and specificity for detection and better localization of tumors in primary staging, but also in previously treated and anatomically distorted anatomy.…”

Definition of Internal Mammary Node Target Volume Based on the Position of the Internal Mammary Sentinel Lymph Nodes Presented on SPECT/CT Fusion Images

“…Therefore, whether based on the literature reports or the results of this study, the lateral and medial boundary of CTV RTOG and CTV DBCG were significantly small. Besides, Borm et al (29) found that in 55 positive IMNs presented on fluorine 18 fluorodeoxyglucose/computed tomography (18FDG-PET/CT), only two IMNs were completely within the described margins and a volume of 41.4 and 38.5% of the lymph nodes were included in the RTOG and ESTRO delineation, respectively. Our data showed that 18.4% of the central points and 5.1% of IM-SLN 5mm s were located within the CTV RTOG , and 60.3% of the central points and 27.9% of IM-SLN 5mm s were located within the CTV DBCG .…”