内乳淋巴结清扫术后患者内乳靶区不同勾画方法比较研究  

Comparison of different delineation methods of clinical target volume of internal mammary lymph node for patients after internal mammary lymph node dissection

作　　者：王雪 王玮[2] 李建彬 郑刚 张文玉 Wang Xue;Wang Wei;Li Jianbin;Zheng Gang;Zhang Wenyu(Shandong First Medical University and Shandong Academy of Medical Sciences,Ji'nan 250200,China;Department of Radiation Oncology,Shandong Cancer Hospital and Institute,Shandong First Medical University and Shandong Academy of Medical Sciences,Ji'nan 250117,China;Department of Breast Surgery,Shandong Cancer Hospital and Institute,Shandong First Medical University and Shandong Academy of Medical Sciences,Ji'nan 250117,China;Department of Imaging,Shandong Cancer Hospital and Institute,Shandong First Medical University and Shandong Academy of Medical Sciences,Ji'nan 250117;Tianjin Normal University,Tianjin 300387,China)

机构地区：[1]山东第一医科大学(山东省医学科学院),济南250200 [2]山东省肿瘤防治研究院(山东省肿瘤医院),山东第一医科大学(山东省医学科学院)胸部放疗一病区,济南250117 [3]山东省肿瘤防治研究院(山东省肿瘤医院),山东第一医科大学(山东省医学科学院)乳腺外科二病区,济南250117 [4]山东省肿瘤防治研究院(山东省肿瘤医院),山东第一医科大学(山东省医学科学院)影像科,济南250117 [5]天津师范大学校内医院,300387

出　　处：《中华放射肿瘤学杂志》2021年第11期1136-1141,共6页Chinese Journal of Radiation Oncology

基　　金：山东省自然科学基金(ZR2020QH260);山东省泰山学者计划(ts20190982)。

摘　　要：目的以内乳淋巴结清扫(ImlND)前勾画的内乳淋巴结临床靶区(CTV_(ImlN))为参照,对比不同勾画方法构建的ImlND术后CTV_(ImlN)靶区间差异,探讨ImlND后CTV_(ImlN)勾画的合理方法。方法选取已行患侧ImlND且术前、术后CT图像资料完整的乳腺癌改良根治术(MRM)患者20例。依据RTOG指南在术前CT图像上勾画健侧及患侧CTV_(Iml)N(CTV_(pr-I)、CTV_(pr-a))。在术后CT图像上分别采用形变配准(DIR)法、视觉对照法、精确测量法勾画术后患侧CTV_(Iml)N,并分别命名为CTVDIR、CTVV、CTVM。比较CTVV、CTVM、CTVDIR与CTV_(pr-a)间靶区中心间距、靶区体积以及3种不同方式构建的CTV_(Iml)N的适形指数(CI)及包含度(DI)差异。结果CTVV、CTVM、CTVDIR与CTV_(pr-a)的靶区中心间距分别为2.17、1.44、1.25cm。CTV_(pr-a)、CTV_(pr-I)、CTVV、CTVM和CTVDIR的靶体积分别为2.10、2.17、2.04、1.88、2.07cm^(3)(均P>0.05)。CTVV-CTV_(pr-a)间、CTVM-CTV_(pr-a)间CI均为0.16,CTVDIR-CTV_(pr-a)间CI为0.43,明显高于前两者(均P<0.01)。CTVV-CTV_(pr-a)、CTVM-CTV_(pr-a)间DI分别为0.26和0.24,CTVDIR-CTV_(pr-a)间DI为0.58,明显高于前两者(均P<0.01)。结论准确勾画ImlND术后的CTV_(Iml)N是困难的,但相比较而言,DIR法所勾画靶区的空间位置适配度优于视觉对照法和精确测量法。Objective To compare the differences of postoperative clinical target volume of internal mammary lymph node(CTV_(ImlN))by different delineation methods,and to explore the reasonable method of CTV_(ImlN)delineation after internal mammary lymph node dissection(ImlND).Methods A total of 20 breast cancer patients who had undergone modified radical mastectomy(MRM)with ImlND on the affected side and had complete preoperative and postoperative CT images were selected.The CTV(CTV_(pr-I),CTV_(pr-a))of both sides of ImlN were delineated on preoperative CT images according to RTOG guideline.On postoperative CT images,three different methods including deformation image registration(DIR)method,visual contrast method and precise measurement method,were employed to delineate the postoperative CTV_(ImlN)of the affected side.The targets were named as CTVDIR,CTVV and CTVM,respectively.The central displacement,target volume,degree of inclusion(DI)and conformity index(CI)of CTV_(pr-a),CTVV,CTVM and CTVDIR were compared.Results The central displacement of CTVV,CTVM and CTVDIR from CTV_(pr-a)was 2.17cm,1.44cm and 1.25cm,respectively.The target volume of CTV_(pr-a),CTV_(pr-I),CTVV,CTVM and CTVDIR was 2.10cm3,2.17cm3,2.04cm3,1.88cm3 and 2.07cm3 respectively.There was no significant difference in the target volume(all P>0.05).The CI values of CTVV-CTV_(pr-a)and CTVM-CTV_(pr-a)were both 0.16,and that of CTVDIR-CTV_(pr-a)was 0.43.The CI value of CTVDIR was significantly higher than those of CTVV and CTVM(both P<0.01).The DI values of CTVV-CTV_(pr-a),CTVM-CTV_(pr-a)and CTVDIR-CTV_(pr-a)were 0.26,0.24 and 0.58,respectively.The DI value of CTVDIR was significantly higher than those of CTVV and CTVM(both P<0.01).Conclusions It is difficult to accurately delineate the CTV_(ImlN)for patients after ImlND.However,the spatial position fitness of the target region delineated by DIR method is better than those by visual contrast and precise measurement methods.

关 键 词：内乳淋巴结清扫术 乳腺肿瘤/放射疗法 靶区勾画 

分 类 号：R737.9[医药卫生—肿瘤]