| Popis: |
BACKGROUNDThe aim of the present study was to generate an atlas of lymphatic drainage in breast cancer patients to be used in cross sectional diagnostic and therapeutic imaging. METHODSThe distribution of healthy lymph nodes is investigated as a surrogate for lymphatic drainage in cross sectional imaging. 2094 healthy LN were contoured contralateral to the primary tumor site on PET-CT datasets of 153 breast cancer patients. Using rigid and non-rigid registration techniques 1939 LN were transferred to a “standard patient” CT data set. Thus, a healthy lymph node atlas was generated. The location of the healthy LN was compared to the RTOG and ESTRO clinical target volumes radiotherapy contouring recommendations.RESULTSThe mean volume of healthy LN was 0.17cm3±0.28cm3 and the mean diameter was 0.77cm±0.36cm. Most LN were in level I (69.20%), supraclavicular (14.80%) and level II (10.50%). The remaining LN were in the internal mammary (2.70%), intraglandular (1.80%) and level III (1.00%). The ESTRO guideline encompassed the healthy LN in 35.00% completely, in 31.10% partly and in 33.90% not at all. The RTOG encompassed 48.00% of the healthy LN completely, 28.80% in part and 23.20% not at all.CONCLUSIONOur study lead to the most comprehensive 3D-imaging atlas of healthy LN in cross sectional imaging. The results can be used to generate a strategy to further reduce the rate of lymphedema by irradiation. Further, the atlas can be used to determine the probability of a visible LN in a specific location to be healthy. |
