It is an irregular clinical procedure that has been controversial. Citation2 Only in cases with gross diseases in level I/II, level III dissection to the thoracic inlet should be performed.ĭissection of level III may lead to postoperative paresthesia, axillary deformity, lymphedema, and so on.

The NCCN Guidelines for clinical practice in breast cancer indicate that in the absence of gross disease in level II nodes, lymph node dissection should include tissue inferior to the axillary vein from the latissimus dorsi muscle laterally to the medial border of the pectoralis minor muscle (level I/II). Indications of Level III Axillary Lymph Node Dissection To analyze whether level III lymph node dissection is necessary, we reviewed the indications, complications, and surgical procedures of level III lymph node dissection. Level I and II axillary lymph dissection is the standard clinical treatment of axillary lymph nodes positive breast cancer, Citation1 whereas level III axillary lymph node dissection has been controversial. Level III lymph nodes are the relay station of mammary gland lymphatic drainage to the supraclavicular lymph nodes or the thoracic duct. The lymph nodes located medially to the pectoralis minor muscle are level III axillary lymph nodes. The lymph nodes located posteriorly to the pectoralis minor muscle’s deep surface are level II axillary lymph nodes. The lymph nodes located laterally to the pectoralis minor muscle are level I axillary nodes, which include the lateral breast group, the central group, and the subscapular group. Anatomically, axillary lymph nodes are divided into three levels, with the pectoralis minor muscle as the boundary. It also is of great importance to evaluate the prognosis and develop treatment plans for breast cancer patients. It is the most reliable method and the golden standard to determine the status of axillary lymph nodes. 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.Īxillary lymph node dissection is an indispensable step in modified radical mastectomy for breast cancer. It is also an important index to estimate the prognosis of breast cancer patients.

Level III axillary lymph node metastasis is one of the important factors that can easily cause distant metastasis and recurrence. 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. Axillary lymph node dissection can be anatomically divided into levels I, II, and III. It is also of great importance to evaluate the prognosis and develop treatment plans for breast cancer patients. Axillary lymph node dissection is an indispensable step in modified radical mastectomy for breast cancer.

Lymph nodes in breast