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Involvement of Level III Axillary Lymph Nodes in Node-Positive Breast Cancer: a Single-Institution Study.

Giridhar Chidananda Murthy1, Preethitha Babu1

  • 1Homi Bhabha Cancer Hospital and Research Centre, Aganampudi Village, Gajuwaka Mandal, Visakhapatnam, Andhra Pradesh 530053 India.

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|November 24, 2025
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Summary

Level III axillary lymph node dissection in breast cancer is crucial for patients with positive Level I/II nodes. This procedure helps identify metastasis and improve patient outcomes.

Keywords:
Axillary dissectionBreast cancerLevel IIILymph node

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Area of Science:

  • Oncology
  • Surgical Pathology
  • Breast Cancer Research

Background:

  • Axillary lymph node dissection is vital for breast cancer prognosis and regional control.
  • The clinical significance of Level III lymph node dissection remains less understood.
  • Identifying predictors of Level III nodal involvement is essential for tailored surgical strategies.

Purpose of the Study:

  • To determine the rate of Level III lymph node positivity in breast cancer patients.
  • To identify clinical and pathological factors predicting Level III nodal metastasis.
  • To evaluate the necessity of Level III dissection based on Level I/II nodal status.

Main Methods:

  • Retrospective analysis of 190 breast cancer patients (cT1-3, N0-1, M0) undergoing surgery.
  • Data collected from May 2017 to December 2020 at a tertiary care center.
  • Inclusion of clinical and pathological details from electronic medical records.

Main Results:

  • Level III nodal positivity was observed in 23.15% of patients with positive Level I/II nodes.
  • Skip metastasis (Level III positive, Levels I/II negative) occurred in 0.52% of cases.
  • Significant correlations found between Level III metastasis and positive Level I/II nodes, lymphovascular invasion, tumor size, and extranodal extension.

Conclusions:

  • Level III axillary lymph node dissection is recommended for all breast cancer patients with positive Level I/II axillary lymph nodes.
  • Findings support the routine inclusion of Level III dissection in surgical planning for specific patient groups.
  • This approach enhances prognostic accuracy and regional control in breast cancer management.