Diagnosis of IM Nodal Metastases in Breast Cancer

描述(逐字摘自申请人的摘要)：最近随机调查的两个人 前瞻性研究，包括不列颠哥伦比亚省(BC)癌症的一项研究 机构的研究表明，胸壁和结节床的辅助照射 引流乳房可提高存活率，即使只有1-3岁的患者也是如此 腋窝淋巴转移。尽管这种方法包括治疗 内乳房结节(IMN)链，IMN照射的重要性是 未知，以及将IMN放射治疗纳入手术后放射治疗 仍然存在争议。这是由于以下事实：(1)只有 接受结节床辅助放射治疗的患者实际上有 IMN转移和(2)IMN放射治疗携带潜在的心、肺和 纵隔毒性。目前的临床实践不包括IMN活检，在 部分原因是非定向IMN抽样的发病率。FDG PET是一种非侵入性的 腋窝淋巴结转移的高灵敏度影像检查方法。我们的 初步研究表明，它在检测IMN方面具有很高的准确性。 转移瘤也一样。我们最近的工作还表明，淋巴测绘 皮损周围注射和淋巴核素扫描可以确定哪些肿瘤有引流 移民局。我们假设一种诊断IMN转移的循序渐进的方法 FDGPET诊断大转移瘤及核素淋巴显像 引流至IMN可以选择患者进行IMN活检和放射治疗。一次 经过验证，这种方法将合理地选择接受IMN放射治疗的患者 而且只需要对部分患者进行IMN活组织检查。我们提出了一个 诊断性研究将是华盛顿大学和华盛顿大学的联合项目 以及不列颠哥伦比亚省癌症机构，作为既定合作的延伸。在……里面 在这项研究中，我们将(1)发展FDGPET和淋巴放射性核素在 识别IMN转移，(2)识别预测较高的 IMN转移的风险，以及(3)开发使用FDG PET帮助计划的方法 放射治疗。这项诊断性研究将提供重要的数据指导 未来的内乳房放射治疗试验。

DESCRIPTION (Verbatim from the Applicant's Abstract): Two recent randomized prospective studies, including a study at the British Columbia (BC) Cancer Agency, have shown that adjuvant irradiation of the chest wall and nodal beds draining the breast improves survival, even in patients with as few as 1-3 axillary Iymph node metastases. Although this approach included treatment to the internal mammary nodal (IMN) chain, the importance of IMN irradiation is unknown, and the inclusion of IMN radiotherapy in post-surgical radiotherapy remain controversial. This is due to the fact that (1) only a subset of patients who are candidates for adjuvant nodal bed radiotherapy actually have IMN metastases and (2) IMN radiotherapy carries potential cardiac, lung, and mediastinal toxicity. Current clinical practice does not include IMN biopsy, in part due to the morbidity of undirected IMN sampling. FDG PET is a non-invasive imaging method with high sensitivity for axillary lymph node metastases. Our preliminary studies suggest that it is highly accurate in detecting IMN metastases as well. Our recent work has also shown that lymphatic mapping with peri-lesional injection and lymphoscintigraphy can determine which tumors drain to the IMN. We hypothesize that a stepwise approach to IMN metastasis diagnosis using FDG PET to identify macrometastases and lymphoscintigraphy to identify drainage to the IMN can select patients for IMN biopsy and radiotherapy. Once validated this approach would rationally select patients for IMN radiation therapy and would require IMN biopsy in only a subset of patients. We propose a diagnostic study which will be a joint project between University of Washington and the BC Cancer Agency as an extension of an established collaboration. In this study we will (1) develop the role of FDG PET and lymphoscintigraphy in identifying IMN metastases, (2) identify tumor features that predict a higher risk for IMN metastases, and (3) develop methods for using FDG PET to help plan radiotherapy. This diagnostic study will provide important data to direct future internal mammary radiotherapy trials.