乳腺癌前哨淋巴结 (SLN) 的识别和评估对于优化患者管理非常重要。本研究的目的是开发交互式 3D 乳腺 SLN 图谱，并对淋巴引流模式和肿瘤患病率进行统计分析。共纳入 861 名术前接受淋巴闪烁扫描和 SPECT/CT 的早期乳腺癌患者。使用贝叶斯推理、非参数引导和回归技术计算淋巴引流和肿瘤患病率统计数据。对 350 名患者进行了 SPECT/CT 与参考患者 CT 的图像配准，并且 SLN 位置相对于参考 CT 进行了转换。参考 CT 被分段，以可视化骨骼和肌肉，以及与欧洲治疗放射学和肿瘤学协会 (ESTRO) 临床靶区 (CTV) 相比的 SLN 分布。 SLN 图谱和统计分析被集成到图形用户界面 (GUI) 中。直接淋巴引流至腋窝 I 级（前）淋巴结区最常见（77.2%），其次是内乳淋巴结区（30.4%）。乳房外上象限的肿瘤患病率最高（22.9%），其次是乳晕后区域（12.8%）。 3D 图谱包含来自 335 名患者的 765 个 SLN，其中 33.3-66.7% 的腋窝 SLN 和 25.4% 的内乳 SLN 被 ESTRO CTV 覆盖。交互式 3D 图谱有效地显示了大型患者队列的乳房 SLN 分布和统计数据。该图集可免费下载，是宝贵的教育资源，可用于将来指导治疗。© 2024。作者。

The identification and assessment of sentinel lymph nodes (SLNs) in breast cancer is important for optimised patient management. The aim of this study was to develop an interactive 3D breast SLN atlas and to perform statistical analyses of lymphatic drainage patterns and tumour prevalence.A total of 861 early-stage breast cancer patients who underwent preoperative lymphoscintigraphy and SPECT/CT were included. Lymphatic drainage and tumour prevalence statistics were computed using Bayesian inference, non-parametric bootstrapping, and regression techniques. Image registration of SPECT/CT to a reference patient CT was carried out on 350 patients, and SLN positions transformed relative to the reference CT. The reference CT was segmented to visualise bones and muscles, and SLN distributions compared with the European Society for Therapeutic Radiology and Oncology (ESTRO) clinical target volumes (CTVs). The SLN atlas and statistical analyses were integrated into a graphical user interface (GUI).Direct lymphatic drainage to the axilla level I (anterior) node field was most common (77.2%), followed by the internal mammary node field (30.4%). Tumour prevalence was highest in the upper outer breast quadrant (22.9%) followed by the retroareolar region (12.8%). The 3D atlas had 765 SLNs from 335 patients, with 33.3-66.7% of axillary SLNs and 25.4% of internal mammary SLNs covered by ESTRO CTVs.The interactive 3D atlas effectively displays breast SLN distribution and statistics for a large patient cohort. The atlas is freely available to download and is a valuable educational resource that could be used in future to guide treatment.© 2024. The Author(s).