Dissection of Level III Axillary Lymph Nodes in Breast Cancer

Abstract

Axillary lymph node dissection is an indispensable step in modified radical mastectomy for breast cancer. It is the most reliable method and the golden standard to determine the status of axillary lymph nodes. It is also of great importance to evaluate the prognosis and develop treatment plans for breast cancer patients. Axillary lymph node dissection can be anatomically divided into levels I, II, and III. Level I and Level II axillary lymph dissection is the standard clinical treatment of axillary lymph nodes positive breast cancer, whereas level III axillary lymph node dissection has been controversial. Level III axillary lymph node metastasis is one of the important factors that can easily cause distant metastasis and recurrence. It is also an important index to estimate the prognosis of breast cancer patients. To facilitate the decision of whether or not to perform level III lymph node dissection, we reviewed the indications, complications, and surgical procedures of level III lymph node dissection.

The Role of Level III Dissection in Locally Advanced Breast Cancer following Neoadjuvant Chemotherapy—A Prospective Study

“…The breast conservation surgery has been accepted for the breast primary with evidences with 20 years follow-up data proving its equivalence to mastectomy. 21 22 SLNB has revolutionalized the management of N0 axilla in the primary surgery setting. 5 In the post-NACT setting, the role of SLNB is not proven in node-positive axilla.…”

“…Level III nodes were defined as nodes identified in the space bounded laterally by the medial margin of pectoralis minor muscle, superiorly by the axillary vein and medially by the thoracic inlet (costoclavicular ligament). 22 Levels I, II, and III nodes were dissected and sent for histology separately. A subgroup analysis based on age, menopausal status, prechemotherapy T and N stage, grade, HR status, HER2 status, response to NACT, and post-NACT clinical stage was done.…”

Síndrome da Rede Axilar após Tratamento para Câncer de Mama: Revisão Sistemática com Metanálise

“…Anatomicamente, os gânglios linfáticos axilares são divididos em três níveis, com o músculo peitoral menor como demarcação. Os linfonodos localizados lateralmente ao peitoral menor são os linfonodos axilares nível I, que incluem o grupo mamário lateral, o grupo central e o grupo subescapular; os localizados posteriormente à superfície profunda do peitoral menor são nível II; e os localizados medialmente ao peitoral menor são nível III 30,31 .…”

“…Com isso, a BLS tem um efeito profundo na redução do trauma axilar, por causar menos lesão linfonodal. Na maioria dos casos, a BLS substituiu a dissecção axilar em pacientes com linfonodos clinicamente negativos 21,30,31 .…”

Future Directions in the Assessment of Axillary Lymph Nodes in Patients with Breast Cancer

“…Many efforts have been made to establish the best diagnostic test to assess ALN status prior to treatment, thus avoiding overtreatment of women with ALN-negative BC. Removal of the involved lymph nodes was considered crucial for cure, as was that of the uninvolved lymph nodes for adequate staging [ 4 , 5 ]. Although NSABP B-04 results show no improvement in survival with ALND [ 6 ], such a strategy remained necessary to identify patients with lymph node involvement for whom adjuvant chemotherapy has been indicated.…”