Axillary lymph nodes

Axillary lymph nodes
	Lymphatics of the breast and the axillary glands
	Axillary lymphatic plexus; Cubital lymph nodes (not part of the lymph node drainage of the breast); Superficial axillary (low axillary); Deep axillary lymph nodes; Brachial axillary lymph nodes; Interpectoral axillary lymph nodes (Rotter nodes); Paramammary or intramammary lymph nodes; Parasternal lymph nodes (internal mammary nodes);
Details
System	Lymphatic system
Drains from	Axilla
Identifiers
Latin	Nodi lymphoidei axillares
TA	A13.3.01.002
FMA	12771
	Anatomical terminology [ edit on Wikidata]

Last updated August 04, 2020

The axillary lymph nodes or armpit lymph nodes are lymph nodes in the human armpit. Between 20 and 49 in number, they drain lymph vessels from the lateral quadrants of the breast, the superficial lymph vessels from thin walls of the chest and the abdomen above the level of the navel, and the vessels from the upper limb. They are divided in several groups according to their location in the armpit. These lymph nodes are clinically significant in breast cancer, and metastases from the breast to the axillary lymph nodes are considered in the staging of the disease.^[1]

Structure

The axillary lymph nodes are arranged in six groups:

Anterior (pectoral) group: Lying along the lower border of the pectoralis minor behind the pectoralis major, these nodes receive lymph vessels from the lateral quadrants of the breast and superficial vessels from the anterolateral abdominal wall above the level of the umbilicus.
Posterior (subscapular) group: Lying in front of the subscapularis muscle, these nodes receive superficial lymph vessels from the back, down as far as the level of the iliac crests.
Lateral group: Lying along the medial side of the axillary vein, these nodes receive most of the lymph vessels of the upper limb (except those superficial vessels draining the lateral side—see infraclavicular nodes, below).
Central group: Lying in the center of the axilla in the axillary fat, these nodes receive lymph from the above three groups.
Infraclavicular (deltopectoral) group: These nodes are not strictly axillary nodes because they are located outside the axilla. They lie in the groove between the deltoid and pectoralis major muscles and receive superficial lymph vessels from the lateral side of the hand, forearm, and arm.
Apical group: Lying at the apex of the axilla at the lateral border of the 1st rib, these nodes receive the efferent lymph vessels from all the other axillary nodes.

The apical nodes drain into the subclavian lymph trunk. On the left side, this trunk drains into the thoracic duct; on the right side, it drains into the right lymphatic duct. Alternatively, the lymph trunks may drain directly into one of the large veins at the root of the neck.^[2]

Breast cancer

About 75% of lymph from the breasts drains into the axillary lymph nodes, making them important in the diagnosis and staging of breast cancer. A doctor will usually refer a patient to a surgeon to have an axillary lymph node dissection to see if the cancer cells have been trapped in the nodes. For clinical stages I and II breast cancer, axillary lymph node dissection should only be performed after first attempting sentinel node biopsy.^[3]

If cancer cells are found in the nodes it increases the risk of metastatic breast cancer. Another method of determining breast cancer spread is to perform an endoscopic axillary sentinel node biopsy. This involves injecting a dye into the breast lump and seeing which node it first spread to (the sentinel node). This node is then removed and examined. If there is no cancer present, it is assumed the cancer has not spread to the other lymph nodes. This procedure is often less invasive and less damaging than the axillary lymph node dissection. The estimated risk of lymphedema following sentinel lymph node procedure is less than 3%.^{[ citation needed ]} The approximate risk of lymphedema following axillary lymph node dissection is 10-15% and this can slightly increase with the addition of radiotherapy and chemotherapy to as much as 20-25% depending on the extent of dissection, extent of radiotherapy fields, and history of chemotherapy.^{[ citation needed ]}

On CT scan or MRI, axillary lymphadenopathy can be defined as solid nodes measuring more than 1.5 cm without fatty hilum.^[4] Lymph nodes may be normal up to 3 cm if consisting largely of fat.^[4]

Axillary lymph nodes are included within the standard tangential fields in radiotherapy for breast cancer. In the case of comprehensive nodal irradiation, which includes axillary levels I, II, and III, as well as a supraclavicular lymph node field, there is a risk of damage to brachial plexus. The risk is estimated to be less than 5% as the brachial plexus radiation tolerance according to (Emami 1991) is 60 Gy in standard fractionation (2 Gy per fraction).^{[ citation needed ]} A common prescribed dose for breast cancer with comprehensive nodal fields would be 50 Gy in 25 fractions with a boost planned to the lumpectomy cavity in the breast or scar on the chest wall if it is a mastectomy. If brachial plexopathy does occur, it is generally a late effect and may not manifest itself until 10 or 15 years later, and usually presents with slight painless muscular atrophy.

Malignancies in the gastrointestinal system like gastric cancer can metastasize to the left axillary lymph node which is called "Irish’s node".^[5]

Additional images

The superficial lymph glands and lymphatic vessels of the upper extremity

Related Research Articles

Lymphedema, also known as lymphoedema and lymphatic edema, is a condition of localized swelling caused by a compromised lymphatic system. The lymphatic system functions as a critical portion of the body's immune system and returns interstitial fluid to the bloodstream. Lymphedema is most frequently a complication of cancer treatment or parasitic infections, but it can also be seen in a number of genetic disorders. Though incurable and progressive, a number of treatments can improve symptoms. Tissues with lymphedema are at high risk of infection because the lymphatic system has been compromised.

The lymphatic system, or lymphoid system, is an organ system in vertebrates that is part of the circulatory system and the immune system. It is made up of a large network of lymphatic vessels, lymphatic or lymphoid organs, and lymphoid tissues. The vessels carry a clear fluid called lymph towards the heart.

A lymph node, or lymph gland is a kidney-shaped organ of the lymphatic system, and the adaptive immune system. A large number of lymph nodes are linked throughout the body by the lymphatic vessels. They are major sites of lymphocytes that include B and T cells. Lymph nodes are important for the proper functioning of the immune system, acting as filters for foreign particles including cancer cells, but have no detoxification function.

The long thoracic nerve supplies the serratus anterior muscle. This nerve characteristically arises from the anterior rami of three spinal nerve roots: the fifth, sixth, and seventh cervical nerves (C5-C7) although the root from C7 may be absent. The roots from C5 and C6 pierce through the scalenus medius, while the C7 root passes in front of the muscle.

The axilla is the area on the human body directly under the joint where the arm connects to the shoulder. It also contains many sweat glands.

Lymphadenectomy or lymph node dissection is the surgical removal of one or more groups of lymph nodes. It is almost always performed as part of the surgical management of cancer. In a regional lymph node dissection, some of the lymph nodes in the tumor area are removed; in a radical lymph node dissection, most or all of the lymph nodes in the tumor area are removed.

Inguinal lymph nodes are lymph nodes in the human groin. Located in the femoral triangle of the inguinal region, they are grouped into superficial and deep lymph nodes. The superficial have three divisions: the superomedial, superolateral, and inferior superficial.

The periaortic lymph nodes are a group of lymph nodes that lie in front of the lumbar vertebrae near the aorta. These lymph nodes receive drainage from the gastrointestinal tract and the abdominal organs.

Lumpectomy is a surgical removal of a discrete portion or "lump" of breast tissue, usually in the treatment of a malignant tumor or breast cancer. It is considered a viable breast conservation therapy, as the amount of tissue removed is limited compared to a full-breast mastectomy, and thus may have physical and emotional advantages over more disfiguring treatment. Sometimes a lumpectomy may be used to either confirm or rule out that cancer has actually been detected. A lumpectomy is usually recommended to patients whose cancer has been detected early and who do not have enlarged tumors. Although a lumpectomy is used to allow for most of the breast to remain intact, the procedure may result in adverse affects that can include sensitivity and result in scar tissue, pain, and possible disfiguration of the breast if the lump taken out is significant. According to National Comprehensive Cancer Network guidelines, lumpectomy may be performed for ductal carcinoma in situ (DCIS), invasive ductal carcinoma, or other conditions.

In human anatomy, the axillary artery is a large blood vessel that conveys oxygenated blood to the lateral aspect of the thorax, the axilla (armpit) and the upper limb. Its origin is at the lateral margin of the first rib, before which it is called the subclavian artery.

The subclavius is a small triangular muscle, placed between the clavicle and the first rib. Along with the pectoralis major and pectoralis minor muscles, the subclavius muscle makes up the Anterior Axioappendicular Muscles also known as anterior wall of the axilla.

The sentinel lymph node is the hypothetical first lymph node or group of nodes draining a cancer. In case of established cancerous dissemination it is postulated that the sentinel lymph node/s is/are the target organs primarily reached by metastasizing cancer cells from the tumor.

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A brachial lymph nodes are group of four to six lymph nodes which lies in relation to the medial and posterior aspects of the axillary vein; the afferents of these glands drain the whole arm with the exception of that portion whose vessels accompany the cephalic vein.

Supraclavicular lymph nodes are lymph nodes found above to the clavicle, that can be felt in the supraclavicular fossa. The supraclavicular lymph nodes on the left side are called Virchow's nodes.

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The superficial lateral cervical lymph nodes are found along the course of the external jugular vein, between the inferior aspect of the parotid gland and the supraclavicular nodes. The nodes are intercalated along the course of the vessels draining the parotid nodes and the infraauricular nodes. These nodes drain into the supraclavicular nodes, and on to the jugular trunk, followed by the thoracic duct on the left or the right lymphatic duct.

Axillary dissection is a surgical procedure that incises the axilla, usually in order to identify, examine, or take out lymph nodes. The term "axilla" refers to the armpit or underarm section of the body. The axillary dissection procedure is commonly used in treating the underarm portion of women who are dealing with breast cancer. The lymph nodes located in the axilla area that are affected by breast cancer are called the guardian or sentinel lymph nodes. Lymph nodes are essential to the lymphatic/immune system due to their main function of filtering unrecognized particles and molecules. The idea of treating breast cancer with the axillary dissection procedure was introduced in the 18th century and was backed by German physician Lorenz Heister. There are certain criteria that make patients eligible candidates for this procedure. Patients tend to have three different levels of axillary lymph nodes; the level helps to determine whether or not the patient should undergo axillary dissection.

References

↑ Longo, D; Fauci, A; Kasper, D; Hauser, S; Jameson, J; Loscalzo, J (2012). Harrison's Principles of Internal Medicine (18th ed.). New York: McGraw-Hill. pp. 757–759. ISBN 978-0071748896.
↑ Richard S. Snell (2011-10-28). Clinical Anatomy by Regions . Lippincott Williams & Wilkins. p. 356. ISBN 978-1-60913-446-4.
↑ American College of Surgeons (September 2013), "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation , American College of Surgeons, retrieved 2 January 2013, which cites various primary research studies.
1 2 Page 559 in: Wolfgang Dähnert (2011). Radiology Review Manual. Lippincott Williams & Wilkins. ISBN 9781609139438.
↑ Dragovich, Tomislav; Kindler, Hedy Lee (2002). "Nonsurgical Palliative Therapy of Advanced Gastric Cancer". In Posner, Mitchell C; Vokes, Everett E; Weichselbaum, Ralph R (eds.). Cancer of the upper gastrointestinal tract. Hamilton: PMPH-USA. p. 290. ISBN 9781550091014.

External links

Image at breastcancer.org
lesson3axillarylymphnodes at The Anatomy Lesson by Wesley Norman (Georgetown University)

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[harrison's-1] Longo, D; Fauci, A; Kasper, D; Hauser, S; Jameson, J; Loscalzo, J (2012). Harrison's Principles of Internal Medicine (18th ed.). New York: McGraw-Hill. pp. 757–759. ISBN 978-0071748896.

[2] Richard S. Snell (2011-10-28). Clinical Anatomy by Regions . Lippincott Williams & Wilkins. p. 356. ISBN 978-1-60913-446-4.

[ACSfive-3] American College of Surgeons (September 2013), "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation , American College of Surgeons, retrieved 2 January 2013, which cites various primary research studies.

[dahnert2011-4] 1 2 Page 559 in: Wolfgang Dähnert (2011). Radiology Review Manual. Lippincott Williams & Wilkins. ISBN 9781609139438.

[5] Dragovich, Tomislav; Kindler, Hedy Lee (2002). "Nonsurgical Palliative Therapy of Advanced Gastric Cancer". In Posner, Mitchell C; Vokes, Everett E; Weichselbaum, Ralph R (eds.). Cancer of the upper gastrointestinal tract. Hamilton: PMPH-USA. p. 290. ISBN 9781550091014.