title: A simplified CT-based definition of the supraclavicular and infraclavicular nodal volumes in breast cancer.
abstract: OBJECTIVE
  The available contouring guidelines for the supraclavicular and infraclavicular lymph nodes appeared to be inadequate for their delineation on non-enhanced computed tomography (CT) scans. For this purpose, we developed delineation guidelines for the clinical target volumes (CTV) of these lymph nodes on non-enhanced CT-slices performed in the treatment position of breast cancer.
  
  
  METHODS
  A fresh female cadaver study as well as delineation and an anatomical descriptions review were performed to propose a simplified definition of the supra- and infraclavicular lymph nodes using readily identifiable anatomical structures. This definition was developed jointly by breast radiologists, breast surgeons, and radiation oncologists. To validate these guidelines, the primary investigator and seven radiation oncologists (observers) independently delineated 10 different nodal CTVs. The primary investigator contours were considered to be the gold standard contours. Contour accuracy and concordance were evaluated.
  
  
  RESULTS
  Written guidelines for the delineation of supra- and infraclavicular lymph nodes CTVs were developed. Consistent contours with minimal variability existed between the delineated volumes; the mean kappa index was 0.83. The mean common contoured and additional contoured volumes were 84.6% and 18.5%, respectively. The mean overlap volume ratio was 0.71.
  
  
  CONCLUSIONS
  Simplified CT-based atlas for delineation of the supra- and infraclavicular lymph nodes for locoregional irradiation of the breast on non-enhanced CT-scan, have been developed in this study. This atlas provides a consistent set of guidelines for delineating these volumes.
authors: Service de radiothérapie, hôpital Bretonneau, centre régional universitaire de cancérologie Henry-S.-Kaplan, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France. alotain2002@gmail.com
authors: I
authors: I
authors: Atean
authors: Y
authors: Y
authors: Pointreau
authors: L
authors: L
authors: Ouldamer
authors: C
authors: C
authors: Monghal
authors: A
authors: A
authors: Bougnoux
authors: G
authors: G
authors: Bera
authors: I
authors: I
authors: Barillot
mesh_terms: D001271:Atlases as Topic; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000532:radiotherapy; D002102:Cadaver; D005260:Female; D005602:France; D013502:General Surgery; D006785:Hospitals, University; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008198:Lymph Nodes / Q000033:anatomy & histology / Q000000981:diagnostic imaging* / Q000473:pathology; D015182:Lymphatic Irradiation; D008207:Lymphatic Metastasis / Q000517:prevention & control / Q000532:radiotherapy; D015588:Observer Variation; D009929:Organ Size; D017410:Practice Guidelines as Topic; D018787:Radiation Oncology; D011871:Radiology; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods* / Q000592:standards; D018714:Radiotherapy, Adjuvant; D014057:Tomography, X-Ray Computed / Q000592:standards