Regional radiotherapy (RT) is increasingly used in breast cancer treatment. Conventionally, computed tomography (CT) is performed for RT planning. Lymph node (LN) target levels are delineated according to anatomical boundaries. Magnetic resonance imaging (MRI) could enable individual LN delineation. The purpose was to evaluate the applicability of MRI for LN detection in supine treatment position, before and after sentinel-node biopsy (SNB). Twenty-three female breast cancer patients (cTis-3N0M0) underwent 1.5 T MRI, before and after SNB, in addition to CT. Endurance for MRI was monitored. Axillary levels were delineated. LNs were identified and delineated on MRI from before and after SNB, and on CT, and compared by Wilcoxon signed-rank tests. LN locations and LN-based volumes were related to axillary delineations and associated volumes. Although postoperative effects were visible, LN numbers on postoperative MRI (median 26 LNs) were highly reproducible compared to preoperative MRI when adding excised sentinel nodes, and higher than on CT (median 11, p < 0.001). LN-based volumes were considerably smaller than respective axillary levels. Supine MRI of LNs is feasible and reproducible before and after SNB. This may lead to more accurate RT target definition compared to CT, with potentially lower toxicity. With the MRI techniques described here, initiation of novel MRI-guided RT strategies aiming at individual LNs could be possible.

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Keywords breast cancer, lymph nodes, MRI, MRI guidance, radiotherapy, sentinel-node biopsy
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Journal Physics in Medicine and Biology
Van Heijst, T.C.F, Eschbach-Zandbergen, D, Hoekstra, N, van Asselen, B, Lagendijk, J.J.W, Verkooijen, H.M, … Philippens, M.E.P. (2017). Supine MRI for regional breast radiotherapy: Imaging axillary lymph nodes before and after sentinel-node biopsy. Physics in Medicine and Biology, 62(16), 6746–6761. doi:10.1088/1361-6560/aa759f