Apical Axillary Lymph Nodes

nodi lymphoidei axillares apicales

The apical axillary nodes lie at the apex of the axilla, along the medial side of the axillary vein above the pectoralis minor and beneath the clavicle. They are the final common station for all axillary lymph and form level III in breast surgery.

Anatomical Data

Structure & Secretions

Location	Apex of the axilla, medial to the axillary vein, above the upper border of pectoralis minor and below the clavicle (level III)
Receives lymph from	Central axillary lymph nodes All other axillary groups Infraclavicular lymph nodes Upper breast
Lymphatic drainage	Subclavian lymphatic trunk Supraclavicular lymph nodes

Biomechanics

Function & Actions

Provide the final filtering station for lymph leaving the axilla toward the venous system.

Clinical Relevance

Clinical Notes

Involvement of the apical (level III) nodes indicates advanced nodal disease in breast cancer. Their efferent vessels form the subclavian lymphatic trunk, so disease can spread on to the supraclavicular nodes. They are hard to feel because they lie under the clavicle and pectoral muscles.

Pathology

Common Injuries & Conditions

Level III Axillary Metastasis

Breast cancer spread to the apical nodes, associated with higher stage and need for regional radiotherapy.

Venous Compression

Rarely, bulky apical nodal disease compressing the axillary or subclavian vein, causing arm swelling.

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