title: Risk of subclinical micrometastatic disease in the supraclavicular nodal bed according to the anatomic distribution in patients with advanced breast cancer.
abstract: OBJECTIVE
  To determine the anatomic distribution of gross supraclavicular nodes within the supraclavicular fossa using 2-deoxy-2-[F-18] fluoro-d-glucose (FDG) positron emission tomography/computed tomography (PET/CT) scans, and to evaluate likely coverage of specific regions of the supraclavicular fossa using standard radiation fields.
  
  
  METHODS
  We identified 33 patients with advanced or metastatic breast cancer who had a PET/CT scan demonstrating hypermetabolic supraclavicular lymph nodes in 2005. The locations of the involved lymph nodes were mapped onto a single CT set of images of the supraclavicular fossa. These lymph nodes were also mapped onto the treatment-planning CT dataset of 4 patients treated in our institution (2 patients with biopsy-proven supraclavicular nodes and 2 patients with clinically negative supraclavicular nodes).
  
  
  RESULTS
  We were able to determine the distribution of 52 supraclavicular lymph nodes in 32 patients. Of 32 patients, 28 (87%) had a history of metastatic disease, and 2 patients had isolated nodal recurrences. Five patients had supraclavicular nodes posterior to the vertebral body transverse process, and several lymph nodes were in close proximity to the medial field border, raising the possibility of geographic miss in these areas.
  
  
  CONCLUSIONS
  In patients with locally advanced disease, increased coverage of the supraclavicular fossa medially and posteriorly may be warranted.
authors.affiliation: Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
authors.forename: Valerie K
authors.initials: VK
authors.lastname: Reed
authors.forename: Jose L
authors.initials: JL
authors.lastname: Cavalcanti
authors.forename: Eric A
authors.initials: EA
authors.lastname: Strom
authors.forename: George H
authors.initials: GH
authors.lastname: Perkins
authors.forename: Julia L
authors.initials: JL
authors.lastname: Oh
authors.forename: Welela
authors.initials: W
authors.lastname: Tereffe
authors.forename: Tse-Kuan
authors.initials: TK
authors.lastname: Yu
authors.forename: Henry
authors.initials: H
authors.lastname: Yeung
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Whitman
authors.forename: Isabelle
authors.initials: I
authors.lastname: Bedrosian
authors.forename: Homer A
authors.initials: HA
authors.lastname: Macapinlac
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Buchholz
authors.forename: Wendy A
authors.initials: WA
authors.lastname: Woodward
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D002968:Clavicle; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18