The axillary lymph nodes are 20-30 nodes embedded in the fat of the armpit. Anatomists divide them into five groups (pectoral, lateral, subscapular, central and apical), while surgeons use three levels defined by the pectoralis minor: level I below it, level II behind it and level III above it. They drain the arm, the breast and the chest and back wall above the umbilicus.
| Location | Within the axillary fat, arranged around the axillary vessels and along the walls of the axilla, from the lower border of pectoralis major up to the apex beneath the clavicle |
|---|---|
| Receives lymph from |
|
| Lymphatic drainage |
|
Filter lymph from the upper limb, breast and upper trunk wall.
About three-quarters of lymph from the breast drains to the axillary nodes, so their status is central to breast cancer staging; sentinel node biopsy has largely replaced routine full clearance. Axillary dissection risks arm lymphoedema and injury to the long thoracic nerve (winged scapula), thoracodorsal nerve and intercostobrachial nerve (numb inner arm). Nodes also enlarge with arm and hand infections and cat scratch disease.
Spread of breast cancer to axillary nodes, a key prognostic factor assessed by sentinel node biopsy or ultrasound-guided sampling.
Chronic swelling of the arm after axillary surgery or radiotherapy disrupts lymph drainage.
Tender nodes in the armpit from infection of the hand, arm or breast, or from cat scratch disease.
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