Skip to main content
SpringerLink
Log in

T-Staging and Target Volume Definition by Imaging in Breast Tumours

  • Chapter
  • First Online:
Imaging and Interventional Radiology for Radiation Oncology

Part of the book series: Medical Radiology ((Med Radiol Diagn Imaging))

  • 605 Accesses

Abstract

Breast cancer is the most frequent cancer in women in both developed and developing countries. Early detection of breast cancer is of great importance, as it allows carrying out less mutilating or aggressive treatments, thus achieving a better quality of life and higher survival rates. The standard of care in breast cancer therefore includes organized screening programs. Mammography and MRI play a key role in both staging of breast lesions and target volume definition. The treatment of breast cancer should be multidisciplinary, involving gynecologists, pathologists, radiologists, surgeons, medical oncologists, and radiation oncologists and nuclear medicine physicians, among others, in order to personalize the treatment of each patient. With the aim of offering the best radiation therapy to patients, but in turn to limit radiation to organs at risk, several imaging techniques are used, which help to define the volumes of treatment: clinical tumour volume (CTV) and planning tumour volume (PTV). Throughout the world, computed tomography (CT) is the most used imaging technique for treatment planning, but we can use the information provided by ultrasound, magnetic resonance, etc., to assist in correctly defining the primary tumour bed and the lymph node regions. Radiation therapy is adapted to the patients’ risks and may include whole-breast, chest wall, regional nodes, or be limited to (accelerated) partial breast irradiation ((A)PBI). Regarding [18F]FDG PET/CT, it has a limited role in the diagnosis of breast cancer, but it can provide relevant information for detecting locoregional and distant disease, for helping to plan surgical and medical treatment, monitoring response, and locating recurrent disease. PET also has the potential to quickly assess new treatments by detecting their effects on specific receptors and has evidenced it improves the prediction of the clinical outcome in previously treated breast cancer patients.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 119.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • ACR BI-RADS Atlas® (n.d.) 5th Edition. https://www.acr.org/Clinical-Resources/Reporting-and-Data-Systems/Bi-Rads

  • Bartelink H, Horiot JC, Poortmans P, Struikmans H, Van den Bogaert W, Barillot I, European Organization for Research and Treatment of Cancer Radiotherapy and Breast Cancer Groups et al (2001) Recurrence rates after treatment of breast cancer with standard radiotherapy with or without additional radiation. N Engl J Med 345:1378–1387

    CAS  PubMed  Google Scholar 

  • Boersma LJ, Janssen T, Elkhuizen PH, Poortmans P, van der Sangen M, Scholten AN et al (2012) Reducing interobserver variation of boost-CTV delineation in breast conserving radiation therapy using a pre-operative CT and delineation guidelines. Radiother Oncol 103:178–182

    PubMed  Google Scholar 

  • Bombardieri E, Crippa F (2001) PET imaging in breast cancer. Q J Nucl Med 45:245–256

    CAS  PubMed  Google Scholar 

  • Brekelmans CT, Seynaeve C, Bartels CC, Tilanus-Linthorst MM, Meijers-Heijboer EJ, Rotterdam Committee for Medical and Genetic Counseling et al (2001) Effectiveness of breast cancer surveillance in BRCA1/2 gene mutation carriers and women with high familial risk. J Clin Oncol 19:924–930

    CAS  PubMed  Google Scholar 

  • Buscombe JR, Holloway B, Roche N, Bombardieri E (2004) Position of nuclear medicine modalities in the diagnostic work-up of breast cancer. Q J Nucl Med Mol Imaging 48:109–118

    CAS  PubMed  Google Scholar 

  • Byrne AM, Hill AD, Skehan SJ, McDermott EW, O'Higgins NJ (2004) Positron emission tomography in the staging and management of breast cancer. Br J Surg 91:1398–1409

    CAS  PubMed  Google Scholar 

  • Champion L, Brain E, Giraudet AL, Le Stanc E, Wartski M, Edeline V et al (2011) Breast cancer recurrence diagnosis suspected on tumor marker rising: value of whole-body 18FDG-PET/CT imaging and impact on patient management. Cancer 117:1621–1629

    PubMed  Google Scholar 

  • Cheng X, Li Y, Liu B, Xu Z, Bao L, Wang J (2012) 18F-FDG PET/CT and PET for evaluation of pathological response to neoadjuvant chemotherapy in breast cancer: a meta-analysis. Acta Radiol 53:615–627

    PubMed  Google Scholar 

  • Chia S, Bryce C, Gelmon K (2005) The 2000 EBCTCG overview: a widening gap. Lancet 365:1665–1666

    CAS  PubMed  Google Scholar 

  • Clarke M, Collins R, Darby S, Davies C, Elphinstone P, Evans V, Early Breast Cancer Trialists' Collaborative Group (EBCTCG) et al (2005) Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet 366:2087–2106

    CAS  PubMed  Google Scholar 

  • Dirisamer A, Halpern BS, Flöry D, Wolf F, Beheshti M, Mayerhoefer ME, Langsteger W (2010) Integrated contrast-enhanced diagnostic whole-body PET/CT as a first-line restaging modality in patients with suspected metastatic recurrence of breast cancer. Eur J Radiol 73:294–299

    PubMed  Google Scholar 

  • Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) (2005) Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet 365:1687–1717

    Google Scholar 

  • Early Breast Cancer Trialists’ Collaborative Group (EBCTCG), Darby S, McGale P, Correa C, Taylor C, Arriagada R, Clarke M et al (2011) Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet 378:1707–1716

    Google Scholar 

  • EBCTCG (Early Breast Cancer Trialists’ Collaborative Group), McGale P, Taylor C, Correa C, Cutter D, Duane F, Ewertz M et al (2014) Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. Lancet 383:2127–2135

    Google Scholar 

  • Esserman L (2005) Integration of imaging in the management of breast cancer. J Clin Oncol 23:1601–1602

    PubMed  Google Scholar 

  • Evangelista L, Baretta Z, Vinante L, Bezzon E, De Carolis V, Cervino AR et al (2012) Comparison of 18F-FDG positron emission tomography/computed tomography and computed tomography in patients with already-treated breast cancer: diagnostic and prognostic implications. Q J Nucl Med Mol Imaging 56:375–384

    CAS  PubMed  Google Scholar 

  • Flanagan FL, Dehdashti F, Siegel BA (1998) PET in breast cancer. Semin Nucl Med 28:290–302

    CAS  PubMed  Google Scholar 

  • García Vicente AM, Soriano Castrejón Á, León Martín A, Relea Calatayud F, Muñoz Sánchez Mdel M, Cruz Mora MÁ et al (2014) Early and delayed prediction of axillary lymph node neoadjuvant response by (18)F-FDG PET/CT in patients with locally advanced breast cancer. Eur J Nucl Med Mol Imaging 41:1309–1318

    PubMed  Google Scholar 

  • Hendrick RE, Smith RA, Rutledge JH III, Smart CR (1997) Benefit of screening mammography in women aged 40–49: a new meta-analysis of randomized controlled trials. J Natl Cancer Inst Monogr 1997:87–92

    Google Scholar 

  • Houssami N, Ciatto S, Macaskill P, Lord SJ, Warren RM, Dixon JM, Irwig L (2008) Accuracy and surgical impact of magnetic resonance imaging in breast cancer staging: systematic review and meta-analysis in detection of multifocal and multicentric cancer. J Clin Oncol 26:3248–3258

    PubMed  Google Scholar 

  • Isasi CR, Moadel RM, Blaufox MD (2005) A meta-analysis of FDG-PET for the evaluation of breast cancer recurrence and metastases. Breast Cancer Res Treat 90:105–112

    CAS  PubMed  Google Scholar 

  • Jadvar H, Colletti PM, Delgado-Bolton R, Esposito G, Krause BJ, Iagaru AH et al (2017) Appropriate use criteria for FDG PET/CT restaging and treatment response assessment of malignant disease. J Nucl Med 58:2026–2037

    CAS  PubMed  Google Scholar 

  • Katz A, Strom EA, Buchholz TA, Thames HD (2000) Locoregional recurrence patterns after mastectomy and doxorubicin-based chemotherapy: implications for postoperative irradiation. J Clin Oncol 18:2817–2827

    CAS  PubMed  Google Scholar 

  • Kumar R, Chauhan A, Zhuang H, Chandra P, Schnall M, Alavi A (2006) Clinicopathologic factors associated with false negative FDG-PET in primary breast cancer. Breast Cancer Res Treat 98:267–274

    PubMed  Google Scholar 

  • Lee CH, Dershaw DD, Kopans D, Evans P, Monsees B, Monticciolo D et al (2010) Breast cancer screening with imaging: recommendations from the Society of Breast Imaging and the ACR on the use of mammography, breast MRI, breast ultrasound, and other technologies for the detection of clinically occult breast cancer. J Am Coll Radiol 7:18–27

    PubMed  Google Scholar 

  • Mandelson MT, Oestreicher N, Porter PL, White D, Finder CA, Taplin SH, White E (2000) Breast density as a predictor of mammographic detection: comparison of interval- and screen-detected cancers. J Natl Cancer Inst 92:1081–1087

    CAS  PubMed  Google Scholar 

  • Manohar K, Mittal BR, Senthil R, Kashyap R, Bhattacharya A, Singh G (2012) Clinical utility of F-18 FDG PET/CT in recurrent breast carcinoma. Nucl Med Commun 33:591–596

    PubMed  Google Scholar 

  • Marta GN, Barrett J, Porfirio GJM, Martimbianco ALC, Bevilacqua JLB, Poortmans P, Riera R (2019) Effectiveness of different accelerated partial breast irradiation techniques for the treatment of breast cancer patients: systematic review using indirect comparisons of randomized clinical trials. Rep Pract Oncol Radiother 24:165–174

    PubMed  PubMed Central  Google Scholar 

  • Miranda FA, Teixeira LAB, Heinzen RN, de Andrade FEM, Hijal T, Buchholz TA et al (2019) Accelerated partial breast irradiation: current status with a focus on clinical practice. Breast J 25:124–128

    PubMed  Google Scholar 

  • Montagne L, Gal J, Chand ME, Schiappa R, Falk AT, Kinj R et al (2019) GEC-ESTRO APBI classification as a decision-making tool for the management of 2nd ipsilateral breast tumor event. Breast Cancer Res Treat. https://doi.org/10.1007/s10549-019-05221-z. [Epub ahead of print]

  • Morris EA, Schwartz LH, Drotman MB, Kim SJ, Tan LK, Liberman L et al (2000) Evaluation of pectoralis major muscle in patients with posterior breast tumors on breast MR images: early experience. Radiology 214:67–72

    CAS  PubMed  Google Scholar 

  • NCCN Clinical practice guidelines in oncology (NCCN guidelines®) guidelines version 1.2019 — march 14, 2019. NCCN.org. Breast Cancer Accessed 31 March 2019. https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf

  • Offersen BV, Boersma LJ, Kirkove C, Hol S, Aznar MC, Biete Sola A et al (2015) ESTRO consensus guideline on target volume delineation for elective radiation therapy of early stage breast cancer. Radiother Oncol 114:3–10

    PubMed  Google Scholar 

  • Pennant M, Takwoingi Y, Pennant L, Davenport C, Fry-Smith A, Eisinga A et al (2010) A systematic review of positron emission tomography (PET) and positron emission tomography/computed tomography (PET/CT) for the diagnosis of breast cancer recurrence. Health Technol Assess 14:1–103

    CAS  PubMed  Google Scholar 

  • Quon A, Gambhir SS (2005) FDG-PET and beyond: molecular breast cancer imaging. J Clin Oncol 23:1664–1673

    CAS  PubMed  Google Scholar 

  • Rahimy E, Weidhaas J, Wei W, Lannin D, Horowitz N, Higgins S et al (2019) Patient-reported outcomes and cosmesis in a feasibility study of 4-dimensional simulated image guided accelerated partial breast irradiation. Pract Radiat Oncol. https://doi.org/10.1016/j.prro.2019.01.013. pii: S1879–8500(19)30047–5. [Epub ahead of print]

  • Raylman RR, Majewski S, Smith MF, Proffitt J, Hammond W, Srinivasan A et al (2008) The positron emission mammography/tomography breast imaging and biopsy system (PEM/PET): design, construction and phantom-based measurements. Phys Med Biol 53:637–653

    PubMed  Google Scholar 

  • Rieber A, Schirrmeister H, Gabelmann A, Nuessle K, Reske S, Kreienberg R et al (2002) Pre-operative staging of invasive breast cancer with MR mammography and/or PET: boon or bunk? Br J Radiol 75:789–798

    CAS  PubMed  Google Scholar 

  • Santiago JF, Gonen M, Yeung H, Macapinlac H, Larson S (2006) A retrospective analysis of the impact of 18F-FDG PET scans on clinical management of 133 breast cancer patients. Q J Nucl Med Mol Imaging 50:61–67

    CAS  PubMed  Google Scholar 

  • Schäfer R, Strnad V, Polgár C, Uter W, Hildebrandt G, Ott OJ, Groupe Européen de Curiethérapie of European Society for Radiotherapy and Oncology (GEC-ESTRO) et al (2018) Quality-of-life results for accelerated partial breast irradiation with interstitial brachytherapy versus whole-breast irradiation in early breast cancer after breast-conserving surgery (GEC-ESTRO): 5-year results of a randomised, phase 3 trial. Lancet Oncol 19:834–844

    PubMed  Google Scholar 

  • Strnad V, Hannoun-Levi JM, Guinot JL, Lössl K, Kauer-Dorner D, Resch A, Working Group Breast Cancer of GEC-ESTRO et al (2015) Recommendations from GEC ESTRO Breast Cancer Working Group (I): target definition and target delineation for accelerated or boost partial breast irradiation using multicatheter interstitial brachytherapy after breast conserving closed cavity surgery. Radiother Oncol 115:342–348

    PubMed  Google Scholar 

  • Strnad V, Major T, Polgar C, Lotter M, Guinot JL, Gutierrez-Miguelez C et al (2018) ESTRO-ACROP guideline: interstitial multi-catheter breast brachytherapy as accelerated partial breast irradiation alone or as boost – GEC-ESTRO Breast Cancer Working Group practical recommendations. Radiother Oncol 128:411–420

    PubMed  Google Scholar 

  • Tabár L, Vitak B, Chen HH, Yen MF, Duffy SW, Smith RA (2001) Beyond randomized controlled trials: organized mammographic screening substantially reduces breast carcinoma mortality. Cancer 91:1724–1731

    PubMed  Google Scholar 

  • Veit-Haibach P, Antoch G, Beyer T, Stergar H, Schleucher R, Hauth EA, Bockisch A (2007) FDG-PET/CT in restaging of patients with recurrent breast cancer: possible impact on staging and therapy. Br J Radiol 80:508–515

    CAS  PubMed  Google Scholar 

  • Vranjesevic D, Filmont JE, Meta J, Silverman DH, Phelps ME, Rao J et al (2002) Whole-body (18)F-FDG PET and conventional imaging for predicting outcome in previously treated breast cancer patients. J Nucl Med 43:325–329

    PubMed  Google Scholar 

  • Wahl RL, Siegel BA, Coleman RE, Gatsonis CG (2004) Prospective multicenter study of axillary nodal staging by positron emission tomography in breast cancer: a report of the staging breast cancer with PET Study Group. J Clin Oncol 22:277–285

    PubMed  Google Scholar 

  • Zangheri B, Messa C, Picchio M, Gianolli L, Landoni C, Fazio F (2004) PET/CT and breast cancer. Eur J Nucl Med Mol Imaging 31(Suppl 1):S135–S142

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, University Hospital San Pedro and Centre for Biomedical Research of La Rioja, Logroño, La Rioja, Spain

    Roberto C. Delgado Bolton

  2. Department of Pathology, University Hospital “Marqués de Valdecilla,”, Santander, Spain

    Adriana K. Calapaquí Terán

  3. Department of Radiation Oncology, Hospital Central de la Defensa “Gómez Ulla”, Madrid, Spain

    Adriana K. Calapaquí Terán

  4. Department of Radiation Oncology, Institut Curie, Paris, France

    Philip Poortmans

  5. Paris Sciences and Lettres, PSL University, Paris, France

    Philip Poortmans

Authors
  1. Roberto C. Delgado Bolton
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Adriana K. Calapaquí Terán
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Philip Poortmans
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Roberto C. Delgado Bolton .

Editor information

Editors and Affiliations

  1. Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands

    Regina G.H. Beets-Tan

  2. Humanitas University and Humanitas Clinical and Research Center, Milan, Italy; Department of Radiology and Nuclear Medicine, Rijnstate Hospital, Arnhem, The Netherlands

    Wim J. G. Oyen

  3. Department of Radiology, Radiation Oncology and Hematology Fondazione Policlinico Universitario A.Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy

    Vincenzo Valentini

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Delgado Bolton, R.C., Calapaquí Terán, A.K., Poortmans, P. (2020). T-Staging and Target Volume Definition by Imaging in Breast Tumours. In: Beets-Tan, R., Oyen, W., Valentini, V. (eds) Imaging and Interventional Radiology for Radiation Oncology. Medical Radiology(). Springer, Cham. https://doi.org/10.1007/978-3-030-38261-2_13

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-38261-2_13

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-38260-5

  • Online ISBN: 978-3-030-38261-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation