Who Needs Level III Lymph Node Dissection in Carcinoma Breast-Study from a Tertiary Care Center

Area of Science:

• Oncology
• Surgical Oncology
• Pathology

Background:

• Breast cancer is the most common cancer in Indian females, often presenting at a late stage.
• Modified radical mastectomy (MRM) is a common treatment, but predictors for extensive lymph node dissection are needed.

Purpose of the Study:

• To identify predictors of level III axillary lymph node metastasis in breast cancer.
• To determine which patients require complete axillary lymph node dissection (ALND).

Main Methods:

• Retrospective study of 146 patients undergoing MRM or breast-conserving surgery (BCS) with ALND.
• Analysis of demographic data, lymph node status (levels I+II), and pathological features.
• Evaluation of factors associated with level III lymph node positivity.

Main Results:

• Level III lymph node metastasis was found in 6% of patients.
• Positivity was associated with older age (median 48.5 years), pathological stage II, and presence of perinodal spread (PNS) and lymphovascular invasion (LVI).
• Level III involvement correlated with >4 positive lymph nodes in levels I+II and pT3 stage or higher.

Conclusions:

• Level III lymph node involvement is rare in early-stage breast cancer but linked to advanced disease indicators.
• Complete ALND is recommended for patients with tumors >5 cm or gross axillary disease.
• These findings aid in tailoring surgical management for breast cancer patients.