Breast LN Boundaries

Question 1

Supraclavicular LN boundaries

Answer 1

CC: caudal cricoid cartilage to caudal edge of clavicle
Anterior: SCM
Posterior: anterior scalene muscle (think: bc don’t need to treat the brachial plexus lol)
Lateral: (cranially: lateral edge of SCM, caudally: junction of 1st rib and clavicle)
Medial: excludes thyroid and trachea

Question 2

Internal Mammary

Answer 2

First three intercostal spaces. Contour the IM vessels + add 5mm, then another 5mm for PTV. Carve off sternum and lung.

(CC: superior aspect of the medial first rib to cranial aspect of the 4th rib)

Question 3

Axilla level III

Answer 3

Remember: III = medial (to pec minor): AND ARE HIGHEST UP
CC: Sup: where pec minor inserts into coracoid process, inf to where axillary vessels cross medial edge of pec major
Ant: post surface of pec minor
Post: ribs and intercostal muscles
Lateral: medial border of pec minor
Medial: thoracic inlet

Question 4

Axilla level II

Answer 4

CC: Sup: where axillary vessels cross medial border of pec minor to inf: where axillary vessels cross lateral edge of pec minor.
Ant: ant surface of pec minor (includes entire pec minor!)
Post: ribs and intercostal muscles
Lateral: lateral border of pec minor
Medial: medial border of pec minor

Question 5

Axilla level I

Answer 5

Remember: axilla level I is lateral, and is the most inf of all axillary levels
CC: Sup: where axillary vessels cross lateral edge of pec minor. Inf: pec major insertion into ribs
Ant: plane defined by anterior surface of pec major and latissmus dorsi
Post: anterior surface of subscapularis muscle
Lateral: medial border of latismus dorsi
Medial: lateral border of pec minor

Question 6

When does the subclavian vessel become the axillary vessel?

Answer 6

Subclavian vessel becomes axillary vessel after it crosses the lateral border of the first rib