Radiological pulmonary findings after breast cancer irradiation: A prospective study

Figures & data

Table I.  Lung abnormalities by score in HRCT scans.

		quantitative analysis
Score	Schratter-Sehn criteria^+	mild	moderate	strong
0	normal
1	thickened septal lines	<5	5–10	>10
2	subpleural lines	1	2–3	>3
3	parenchymal bands	1–3	4–5	>5
4	honeycombing cysts	<5	5–10	>10
5	ground glass	visual assessment

⁺Thickened septal lines = short lines contacting the pleural surface perpendicularly

Subpleural lines = lines of 2 cm or more, parallel to the chest wall

Parenchymal bands = linear, 2–5 cm long non-tapering lines from lung to pleural surface

Honeycombing cysts = areas with small cystic spaces <1 cm in diameter with thickened walls

Ground glass = alveolar fillling, acute radiologic changes

Table II.  Lung reactions by grade detected in plain radiographs after radiotherapy.

	Lung reactions after radiotherapy
	3 months		6 months		12 months
Grade	n	%	n	%	n	%
0	92	54.4	109	61.2	131	84.0
2	38	22.5	50	28.1	25	16.0
3	23	13.6	14	7.9	0	0
4	16	9.5	5	2.8	0	0
Total	169	100	178	100	156	100

Figure 1.  Radiological pulmonary findings (grade 0–4) at 3, 6 and 12 months (mo) after radiotherapy for the patients evincing some reaction at 12 months.

Figure 2.  (a) Mean dose volume histograms (DVHs) for all patients and patients with grade 4 pulmonary findings in plain radiographs at either 3 or 6 months after radiation therapy according to type of operation (BCS = breast conserving surgery), M = mastectomy), and (b) DVHs of four individual patients with grade 4 findings also showing pulmonary symptoms.

Figure 3.  A 57-year old woman (Patient 4) 3 months after radiotherapy of the left breast. Grade-4 lesions = dense uniform opacification in upper lobe and lingula.

Table III.  Lung abnormalities in plain radiographs and in HRCTscans.

Patient	Plain radiograph grade 0–4*	HRCT scan score 0–5** (mild +moderate + + strong + ++)
1	0	1(+ + ) 3(+)
2	2	1(+ + +) 2(+) 3(+)
3	0	1(+ + ) 4(+) 5(+)
4	2	1(+ + +) 2(+)
5	0	1(+)
6	0	1(+ + ) 2(+)
7	3	1(+ + +)
8	2	1(+ + ) 2(+)
9	2	1(+ + ) 2(+) 5(+)
10	0	1(+ + )
11	0	1(+) 2(+) 4(+)
12	2	1(+ + ) 4(+)
13	0	0
14	2	1(+) 2(+)
15	0	0

*grade 0 = normal, grade 2 = linear streaky, grade 3 = dense diffuse opacification, grade 4 = dense uniform opacification

**score 0 = normal, score 1 = thickened septal lines, score 2 = subpleural lines, score 3 = parenchymal bands, score 4 = honeycombing, score 5 = ground glass appearance