Table 1 Suggested CTV delineation
CTV | Cranial | Caudal | Medial | Lateral | Ventral | Dorsal |
|---|---|---|---|---|---|---|
Chest wall | Caudal edge of the sterno-clavicular joint | Caudal edge of the contralateral breast | Within 1 cm to the midline of the body (guided by palpable/visible signs of free skin flap or the contralateral breast) | Mid-axillary line (guided by palpable/visible signs of free skin flap or the contralateral breast) | Skin surface | Anterior edge of the pectoralis minor muscle; includes the pectoralis major muscle and the interpectoral space |
Supraclavicular fossa | Caudal edge of the cricoid cartilage | 5 mm below the subclavian vein | Medial edge of the internal jugular vein, excluding the thyroid and the common carotid artery | Medial edge of the trapezius muscle and the pectoralis minor muscle | Posterior surface of the sternocleido mastoid muscle and platysma muscle | Ventral surface of the scalene muscle bundle |
Infraclavicular fossa (Axilla level III) | Pectoralis minor muscle inserts on the coracoid process | 5 mm caudal to the axillary vein cross medial edge of the pectoralis minor muscle | Medial edge of the collar bone and ribs; lateral edge of the junction of the subclavian and internal jugular veins | Medial edge of the pectoralis minor muscle | Posterior surface of the pectoralis major muscle | Dorsal to the subclavian vein and axillary vein (anterior edge of the ribs) |
Axilla level II | Cranial edge of the pectoralis minor muscle | Caudal edge of the pectoralis minor muscle | Medial edge of the pectoralis minor muscle | Lateral edge of the pectoralis minor muscle | Posterior surface of the pectoralis major muscle | 5 mm dorsal of the axillary vein, or the ventral edge of the ribs and the intercostal muscle |
Axilla level I | Axillary vein cross lateral edge of the pectoralis minor muscle | To the level of rib 4–5 | Lateral edge of the pectoralis minor muscle | Medial edge of the latissimus dorsi muscle | 5 mm anterior the plane defined by the anterior surface of the pectoralis major muscle and the latissimus dorsi muscle | Anterior surface of the subscapularis muscle |
IMN region | 5 mm caudal to the subclavian vein, thus connecting to the caudal border of the infraclavicular fossa | Cranial edge of the fourth rib | 5 mm medial to IM vessels | 5 mm lateral to IM vessels | 5 mm anterior to IM vessels, excluding the chest wall | 5 mm posterior to IM vessels, excluding the lung |