Level 3 Axillary Nodal Status in the Absence of Metastatic Disease in Level 1 and 2 Axillary Node in Carcinoma Breast – A Retrospective Analysis

ABSTRACT

Introduction: The intention of axillary lymph node dissection (ALND) is to stage the axilla precisely for prognostic information.This study is to assess the possibility of skip lesion in Level 3 in the absence of disease in Level 1 and 2 which may help inundertaking randomized controlled study to avoid Level 3 nodal dissection in our patients.Materials and Methods: Retrospective analysis of 60 patients who underwent surgery for invasive breast cancer from October2013 to October 2019 in the Department of Surgical Oncology, Government Thoothukudi Medical College Hospital, Thoothukudi,was performed.Results: About 33.3% of patients (20) were disease free in the axilla and the remaining 66.7% (40) had nodal involvement. Ofthose 39 patients who had nodal involvement in Level 1 and 2, 15 were found to have the disease in 4 or more nodes, 24 hadthe disease in <4 nodes. Totally 16 patients had metastases in Level 3 nodes. There is a 60% chance of involvement of Level3 when there is 4 or more nodal positivity in Level 1 and 2 and it drops to 25% if the involved nodal count becomes <4. Onepatient had skip lesion in Level 3 (4.8%) without disease in Level 1 and 2.Conclusion: Since there has been a dearth of randomized studies about levels of nodes to be addressed in ALND and studiesabout skip lesion in Level 3 from our country, we urge the need for more studies probably multicentric, regarding the extent ofALND. Until then, it may be fruitful to do complete ALND up to Level 3 for the better staging of the axilla.