title: Distribution of axillary lymph node metastases in different levels and groups in breast cancer, a pathological study.
abstract: BACKGROUND
  It was observed during dissection of heavy deposits of axillary lymph nodes (LNs) in breast cancer that there were grossly positive LNs outside the confines of classical axillary dissection.
  
  
  OBJECTIVE
  To know the extent of LN metastases in these new basins by dissecting and labeling them separately, for pathological examination and proper staging of those patients.
  
  
  METHODS
  From 2005 to 2009, 59 private patients with breast cancer who had positive axillary LNs were subjected to axillary dissection with accurate leveling according to its relation to pectoralis minor. In addition to the classical three levels, the brachial, thoracoacromial, humeral, scapular and Rotter's lymph nodes were dissected.
  
  
  RESULTS
  Levels I, II and III axillary LNs were involved in 91.5%, 62.7%, and 52.5%, respectively. Skip metastases (without the involvement of level one) were found in 5/59 patients (8.4%). Brachial, acromiothoracic, humeral and Rotter's LNs were involved in 10.1%, 15.2%, 5% and 1.7%, respectively, with no metastatic deposits encountered in scapular LNs. In our patients, lymphedema of the ipsilateral upper limb was nearly of the same incidence as after classical axillary dissection.
  
  
  CONCLUSIONS
  In addition to the classic complete axillary lymph node dissection (ALND) indicated in patients with breast cancer with axillary LNs metastases, dissection of the brachial, acromiothoracic, humeral, Rotter's and scapular LNs, is recommended for proper staging.
authors.affiliation: Department of Surgical Oncology, National Cancer Institute (NCI), Cairo University, Cairo, Egypt.
authors.forename: Medhat
authors.initials: M
authors.lastname: Khafagy
authors.forename: Ahmed
authors.initials: A
authors.lastname: Mostafa
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Fakhr
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000556:secondary* / Q000601:surgery; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D015411:Mastectomy, Modified Radical; D015412:Mastectomy, Segmental; D008875:Middle Aged; D010369:Pectoralis Muscles / Q000473:pathology / Q000601:surgery; D011446:Prospective Studies; D055815:Young Adult