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

Axillary dissection provides prognostic information and regional control and possibly improves overall survival. The usefulness of level III lymph node dissection is less well studied. The study aims to identify the rate of level III nodal positivity and factors that can predict its involvement. A retrospective analysis of 190 breast cancer patients (cT1-3, N0-1, M0) who underwent surgery (modified radical mastectomy or breast conservation surgery) between May 2017 and December 2020 at a tertiary care centre was done. Clinical and pathological details were obtained from the electronic medical record. The rate of level III nodal positivity in patients with pathologically positive level I/II lymph nodes was 23.15% (n = 22). Skip metastasis in level III without involvement in levels I and II was 0.52% (n = 1). There was a significant correlation between involvement of level I/II lymph nodes (p ≤ 0.001), lymphovascular invasion (p = 0.001), pathological tumour size (p = 0.015), extranodal extension in level 1/2 lymph nodes (p < 0.00001) and level III lymph node metastases. Level III lymph node dissection should be performed in all patients with metastases in level I/II axillary lymph nodes.