Skip to main content
SpringerLink
Log in

Chest Wall and Regional Lymphatics

  • Chapter
  • First Online:
Book cover Principles and Practice of Modern Radiotherapy Techniques in Breast Cancer

  • 2249 Accesses

Abstract

The female breast rests above the anterior thoracic wall superficial to the pectoralis major muscle [1]. The breast tissue usually extends from the midline to near the midaxillary line and cranial-caudally from the second or third anterior rib to the inframammary fold (sixth or seventh anterior rib), depending on the size (Fig. 13.1) [2]. The largest volume of tissue located in the upper-outer quadrant of the breast extending into the region of the low axilla is known as the axillary tail of Spence (Fig. 13.1). This anatomic region is a common site for primary breast carcinomas.

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 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 149.99
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

  1. Harris J, Lippman M, Morrow M, et al. Diseases of the breast. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2004. p. 3–15.

    Google Scholar 

  2. Drew P, Cawthorn S, Michell M. Interventional ultrasound of the breast—anatomy of the breast by Menos Lagopoulos. London, UK: Informa Healthcare; 2007. p. 11–22.

    Google Scholar 

  3. Cooper A. On the anatomy of the breast. London: Harrison and Co Printers; 1840.

    Google Scholar 

  4. Bland K, Copeland E. The breast—comprehensive management of benign and malignant diseases. 4th ed. Philadelphia, PA: Saunders; 2009.

    Google Scholar 

  5. Kirova YM, Servois V, Campana F, et al. CT-scan based localization of the internal mammary chain and supra clavicular nodes for breast cancer radiotherapy planning. Radiother Oncol. 2006;79:310–5.

    Article  PubMed  Google Scholar 

  6. Sappey MPC. Anatomie, Physiologie, Pathologie des vaisseaux Lymphatiques consideres chez L’homme at les Vertebres. A. Delahaye and E. Lecrosnier, Paris; 1874.

    Google Scholar 

  7. Hartveit E. Attenuated cells in breast stroma: the missing lymphatic system of the breast. Histopathology. 1990;16:533–43.

    Article  PubMed  CAS  Google Scholar 

  8. Turner-Warwick RT. The lymphatics of the breast. Br J Surg. 1959;46:574–82.

    Article  PubMed  CAS  Google Scholar 

  9. Sandrucci S, Mussa A. Sentinel lymph node biopsy and axillary staging of T1-T2N0 breast cancer: a multicenter study. Semin Surg Oncol. 1998;15:278–83.

    Article  PubMed  CAS  Google Scholar 

  10. Suami H, Pan WR, Mann GB, Taylor GI. The lymphatic anatomy of the breast and its implications for sentinel lymph node biopsy: a human cadaver study. Ann Surg Oncol. 2008;15:863–71.

    Article  PubMed  Google Scholar 

  11. Sharma A, Fidias P, Hayman A, et al. Patterns of lymphadenopathy in thoracic malignancies. Radiographics. 2004;24:419–34.

    Article  PubMed  Google Scholar 

  12. Perre CI, Hoefnagel CA, Kroon BBR, et al. Altered lymphatic drainage after lymphadenectomy or radiotherapy of the axilla in patients with breast cancer. Br J Surg. 1996;83:1258.

    Article  PubMed  CAS  Google Scholar 

  13. Haagensen CD. Lymphatics of the breast. Philadelphia: WB Saunders Company; 1972. p. 300–87.

    Google Scholar 

  14. Caplan I. Revision anatomique du systeme lymphatique de la glande mammaire (a propos de 200 cas). Bull Assoc Anat (Nancy). 1975;59:121–37.

    CAS  Google Scholar 

  15. Servelle M, Bourdin JS, Zafari I, et al. Les lymphatiques du sein et des muscles pectoraux. Sem Hop. 1972;48:121–7.

    PubMed  CAS  Google Scholar 

  16. Ege GN. Internal mammary lymphoscitigraphie. Radiology. 1976;118:101–7.

    PubMed  CAS  Google Scholar 

  17. Freedman GM, Fowble BL, Nicolaou N, et al. Should internal mammary lymph nodes in breast cancer be a target for the radiation oncologist? Int J Radiat Oncol Biol Phys. 2000;46:805–14.

    Article  PubMed  CAS  Google Scholar 

  18. Scataridge JC, Hamper UM, Sheth S, et al. Parasternal sonography of the internal mammary vessels: technique, normal anatomy, and lymphadenopathy. Thorac Radiol. 1989;172:453–7.

    Google Scholar 

  19. Haagensen CD. Anatomy of the mammary gland. In: Haagensen CD, editor. Diseases of the breast. 2nd ed. Philadelphia, PA: WB Saunders; 1971. p. 1–54.

    Google Scholar 

  20. Noguchi M, Taniya T, Koyasaki N, Miyazaki I. A multivariate analysis of en bloc extended radical mastectomy versus conventional radical mastectomy in operable breast cancer. Int Surg. 1992;77:48–54.

    PubMed  CAS  Google Scholar 

  21. Stibbe EP. The internal mammary lymphatic glands. J Anat. 1918;52:257–64.

    PubMed  CAS  Google Scholar 

  22. Urban JA, Marjani MA. Significance of internal mammary lymph node metastases in breast cancer. Am J Roentgenol. 1971;111:130–6.

    CAS  Google Scholar 

  23. Veronesi U, Banfi A, Salvadori B, et al. Breast conservation is the treatment of choice in small breast cancer: long term results of a randomized trial. Eur J Cancer. 1990;26:668–70.

    Article  PubMed  CAS  Google Scholar 

  24. Overgaard M, Hansen PS, Overgaard J, et al. Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. Danish Breast Cancer Cooperative Group 82b Trial. N Engl J Med. 1997;337:949–55.

    Article  PubMed  CAS  Google Scholar 

  25. Overgaard M, Jensen MB, Overgaard J, et al. Postoperative radiotherapy in high-risk postmenopausal breast-cancer patients given adjuvant tamoxifen: Danish Breast Cancer Cooperative Group DBCG 82c randomized trial. Lancet. 1999;353:1641–8.

    Article  PubMed  CAS  Google Scholar 

  26. Ragaz J, Jackson SM, Le N, et al. Adjuvant radiotherapy and chemotherapy in node-positive premenopausal women with breast cancer. N Engl J Med. 1997;337:956–62.

    Article  PubMed  CAS  Google Scholar 

  27. Whelan TJ, Julian J, Wright J, et al. Does locoregional radiation therapy improve survival in breast cancer? A meta-analysis. J Clin Oncol. 2000;18:1220–9.

    PubMed  CAS  Google Scholar 

  28. Recht A, Edge SB, Solin LJ, et al. Postmastectomy radiotherapy: clinical practice guidelines of the American Society of Clinical Oncology. J Clin Oncol. 2001;19:1539–69.

    PubMed  CAS  Google Scholar 

  29. Noguchi M. Does regional treatment improve the survival in patients with operable breast cancer? Breast Cancer Res Treat. 2002;76:269–82.

    Article  PubMed  CAS  Google Scholar 

  30. Hiraoka M, Mitsumori M, Shibuya K. Adjuvant radiation therapy following mastectomy for breast cancer. Breast Cancer. 2002;9:190–5.

    Article  PubMed  Google Scholar 

  31. Recht A, Gray R, Davidson NE, et al. Locoregional failure 10 years after mastectomy and adjuvant chemotherapy with or without tamoxifen without irradiation: experience of the Eastern Cooperative Oncology Group. J Clin Oncol. 1999;17:1689–700.

    PubMed  CAS  Google Scholar 

  32. Veronesi U, Marubini E, Mariani L, et al. The dissection of internal mammary nodes does not improve the survival of breast cancer patients. 30-year results of a randomised trial. Eur J Cancer. 1999;35:1320–5.

    Article  PubMed  CAS  Google Scholar 

  33. Perez CA, Brady LW. Principles and practice of radiation oncology. 2nd ed. Philadelphia, PA: J.B. Lippincott Company; 1992. p. 877–969.

    Google Scholar 

  34. Gray H. Cardiovascular system. In: Williams PL, Bannister LH, editors. Gray’s anatomy. 38th ed. London: Churchill Livingstone; 1995. p. 1605–26.

    Google Scholar 

  35. Moore KL. The neck. In: Gardner JN, editor. Clinically oriented anatomy. 2nd ed. Baltimore, MD: Williams and Wilkins; 1985. p. 983–1068.

    Google Scholar 

  36. Severin D, Connors S, Thompson H, et al. Breast radiotherapy with inclusion of internal mammary nodes: a comparison of techniques with three-dimensional planning. Int J Radiat Oncol Biol Phys. 2003;55:633–44.

    Article  PubMed  Google Scholar 

  37. Gregoire V, Coche E, Cosnard G, et al. Selection and delineation of lymph node target volumes in head and neck conformal radiotherapy. Proposal for standardizing terminology and procedure based on the surgical experience. Radiother Oncol. 2000;56:135–50.

    Article  PubMed  CAS  Google Scholar 

  38. Halverson KJ, Taylor ME, Perez CA, et al. Regional nodal management and patterns of failure following conservative surgery and radiation therapy for stage I and II breast cancer. Int J Radiat Oncol Biol Phys. 1993;26:593–9.

    Article  PubMed  CAS  Google Scholar 

  39. Recht A, Pierce SM, Abner A, et al. Regional nodal failure after conservative surgery and radiotherapy for early-stage breast carcinoma. J Clin Oncol. 1991;9:988–96.

    PubMed  CAS  Google Scholar 

  40. Du X, Freeman JL, Nattibger AB, Goodwin JS. Survival of women after breast conserving surgery for early stage breast cancer. Breast Cancer Res Treat. 2002;72:23–31.

    Article  Google Scholar 

  41. Strom EA, Woodward WA, Katz A, et al. Clinical investigation: regional nodal failure patterns in breast cancer patients treated with mastectomy without radiotherapy. Int J Radiat Oncol Biol Phys. 2005;63:1508–13.

    Article  PubMed  Google Scholar 

  42. Ouyang T, Li JF, Wang TF, Lin BY. Exploration of the extent of axillary dissection for patients with node positive primary breast cancer. Zhonghua Wai Ke Za Zhi. 2005;43:298–300.

    PubMed  Google Scholar 

  43. Donegan WL. Management of early invasive carcinoma: TNM stage I and II. In: Donegan WL, Spratt JS, editors. Cancer of the breast. 5th ed. Philadelphia, PA: Saunders; 2002. p. 535–66.

    Google Scholar 

  44. Bale A, Gardner B, Shende M, Fromowitz F. Can interpectoral nodes be sentinel nodes? Am J Surg. 1999;178:360–1.

    Article  PubMed  CAS  Google Scholar 

  45. Komenaka IK, Bauer VP, Schnabel FR, et al. Interpectoral nodes as the initial site of recurrence in breast cancer. Arch Surg. 2004;139:175–8.

    Article  PubMed  Google Scholar 

  46. Dijkema IM, Hofman P, Raaijmakers CPJ, et al. Loco-regional conformal radiotherapy of the breast: delineation of the regional lymph node clinical target volumes in treatment position. Radiother Oncol. 2004;71:287–95.

    Article  PubMed  Google Scholar 

  47. Obedian E, Haffty BG. Internal mammary nodal irradiation in conservatively-managed breast cancer patients: is there a benefit? Int J Radiat Oncol Biol Phys. 1999;44:997–1003.

    Article  PubMed  CAS  Google Scholar 

  48. Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). 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 randomized trials. Lancet. 2005;366:2087–106.

    Google Scholar 

  49. Veronesi U, Cascinelli N, Bufalino R, et al. Risk of internal mammary lymph node metastasiss and its relevance on prognosis of breast cancer. Ann Surg. 1983;198:681–4.

    Article  PubMed  CAS  Google Scholar 

  50. Bentel G, Marks LB, Hardenbergh P, et al. Variability of the location of internal mammary vessels and glandular breast tissue in breast cancer patients undergoing routine CT-based treatment planning. Int J Radiat Oncol Biol Phys. 1999;44:1017–25.

    Article  PubMed  CAS  Google Scholar 

  51. Pierce LJ, Butler JB, Martel MK, et al. Postmastectomy radiotherapy of the chest wall: dosimetric comparison of common techniques. Int J Radiat Oncol Biol Phys. 2002;52:1220–30.

    Article  PubMed  Google Scholar 

  52. Cuzick J, Stewart H, Rutqvist L, et al. Cause-specific mortality in long-term survivors of breast cancer who participated in trials of radiotherapy. J Clin Oncol. 1994;12:447–53.

    PubMed  CAS  Google Scholar 

  53. Hurkmans CW, Saarnak AE, Pieters BR, et al. An improved technique for breast cancer irradiation including the locoregional lymph nodes. Int J Radiat Oncol Biol Phys. 2000;47:1421–9.

    Article  PubMed  CAS  Google Scholar 

  54. Hurkmans CW, Borger JH, Bos LJ, et al. Cardiac and lung complication probabilities after breast cancer irradiation. Radiother Oncol. 2000;55:145–51.

    Article  PubMed  CAS  Google Scholar 

  55. Remouchamps VM, Vicini FA, Sharpe MB, et al. Significant reductions in heart and lung doses using deep inspiration breath hold with active breathing control and intensitymodulated radiation therapy for patients treated with locoregional breast irradiation. Int J Radiat Oncol Biol Phys. 2003;55:392–406.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Hacettepe University, Ankara, Turkey

    Gokhan Ozyigit, Melis Gultekin & Ferah Yildiz

Authors
  1. Gokhan Ozyigit
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Melis Gultekin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ferah Yildiz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gokhan Ozyigit .

Editor information

Editors and Affiliations

  1. Faculty of Medicine, Department of Radiation Oncology, Ege University, Ege Unv. Hastanesi, Izmir, 35100, Turkey

    Ayfer Haydaroglu

  2. Faculty of Medicine, Department of Radiation Oncology, Hacettepe University, Hacettepe Hastanesi, Ankara, 06100, Turkey

    Gokhan Ozyigit

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Science+Business Media New York

About this chapter

Cite this chapter

Ozyigit, G., Gultekin, M., Yildiz, F. (2013). Chest Wall and Regional Lymphatics. In: Haydaroglu, A., Ozyigit, G. (eds) Principles and Practice of Modern Radiotherapy Techniques in Breast Cancer. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-5116-7_13

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-5116-7_13

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-5115-0

  • Online ISBN: 978-1-4614-5116-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation