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Original title:
Eine F18-FDG/PET-CT basierte Analyse der Lokalisation von Lymphknotenmetastasen beim Mammakarzinom.
Translated title:
A F18-FDG/PET-CT based analysis concerning localization of lymphatic metastasis in breast cancer.
Author:
Voppichler , Julia
Year:
2022
Document type:
Dissertation
Faculty/School:
Fakultät für Medizin
Advisor:
Duma, Marciana-Nona (Priv.-Doz. Dr.)
Referee:
Duma, Marciana-Nona (Priv.-Doz. Dr.); Lohrmann, Christian (Prof. Dr.)
Language:
de
Subject group:
MED Medizin
TUM classification:
MED 540; MED 320
Abstract:
Ziel dieser Studie war es lokoregionäre Lymphknotenmetastasen bei Mammakarzinompatienten anhand von FDG/PET-CT Datensätzen exakt zu lokalisieren und auf diese Weise Informationen über das Metastasierungsmuster beim Mammakarzinom zu gewinnen. Dabei wurden 235 Patienten mit PET-CT positiven Lymphknotenmetastasen ermittelt und in vier Gruppen eingeteilt: Patienten mit primärer Tumormanifestation ohne Fernmetastasierung, Patienten mit primärer Tumormanifestation mit Fernmetastasierung, Patienten im...     »
Translated abstract:
The aim of this study was to localize locoregional lymph node metastases in breast cancer using fluorodeoxyglucose positron emission tomography data sets in 235 patients with 580 lymph nodes to get a profound understanding of the pattern and localization of lymphatic metastases. The patients were divided into four groups according to their course of disease (primary or recurrent breast cancer) and the presence or absence of distant metastasis at the time of the FDG/PET-CT staging (distant metastasis vs no distant metastasis). All 235 FDG/PET-CT data sets were imported into the planning software, each lymph node metastasis was manually contoured and all contoured structures were registered rigidly and nonrigidly to a patient’s CT data set with “standard anatomy” chosen as a template. To create a comprehensive lymph node atlas in which the number of lymph nodes (n=0-13) in each voxel was represented color-coded, in the next step we summed the binary masks of all contoured structures. Through this we also identified areas in which lymph node metastases accumulate in patients with breast cancer (“hot spots”  13 lymph nodes). To evaluate the RTOG (Radiation Therapy Oncology Group) and ESTRO (European Society for Radiotherapy & Oncology) guidelines lymph node levels (axillary, internal mammary, supraclavicular) were contoured according to their recommendations in the standard patient. Based on the binary masks of the lymph node structures and the contoured lymph node levels, we calculated the overlapping volume (OL) using MATLAB. Both the RTOG clinical target volume (CTV) and the ESTRO CTV cover the majority of the detected lymph node metastases within the lymphatic drainage system. Our results indicate that the lymph node metastases pattern is dependent on the stage of the disease. Recurrent lymph node metastases occur more frequently in the supraclavicular and internal mammary region compared with primary nodal disease. Neither the ESTRO nor the RTOG atlas reliably reflects all the involved lymph node regions. Both primary and recurrent lymph node metastases exceeded the cranial border of levels I to IV and the lateral border of level I as well as the dorsolateral border of level IV (supraclavicular level). The occurrence of LN metastases outside the RTOG and ESTRO margins in patients with and without distant metastasis was similar. However, the ESTRO CTV and RTOG CTV do not provide coverage of the whole locoregional lymphatic drainage. It seems to be important to reevaluate the existing contouring guidelines of the RTOG and ESTRO regarding their clinical target volume especially in an extended disease setting to maybe adjust the CTV individually. Whether target volumes that cover the whole locoregional lymphatic drainage system are necessary and result in an improved oncological outcome is left to future studies to examine.
WWW:
https://mediatum.ub.tum.de/?id=1615616
Date of submission:
06.07.2021
Oral examination:
11.03.2022
File size:
23816124 bytes
Pages:
112
Urn (citeable URL):
https://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:91-diss-20220311-1615616-1-4
Last change:
11.07.2022
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