Anatomy
Upper Limb
Question 36 of 180
A 40 year old woman is found to have a suspicious breast lump just superior and lateral to the areolar region of her left breast. She undergoes a sentinel lymph node biopsy. Which of the following lymph nodes will most likely first encounter lymph from the tumour:
Answer:
Approximately 75% of lymph drainage from the breast is via lymphatic vessels that drain laterally and superiorly into axillary nodes. The lymph usually first drains to anterior axillary nodes, and from here, through central axillary, apical and supraclavicular nodes in sequence. Axillary nodes primarily drain to the subclavian lymph trunk.Lymphatic Drainage of Breast
Anatomy / Upper Limb / Breast
Last Updated: 20th February 2019
The lymphatic drainage of the breast is of great clinical importance due to its role in the metastasis of breast cancer cells.
There are three main groups of lymph nodes that receive lymph from breast tissue:
- Approximately 75% of lymphatic drainage is via lymphatic vessels that drain laterally and superiorly into axillary lymph nodes.
- Most of the remainder (20%) is into medial parasternal lymph nodes, which lie deep to the anterior thoracic wall associated with the internal thoracic artery.
- Some drainage (5%) may follow the lateral branches of posterior intercostal arteries and connect with posterior intercostal lymph nodes situated near the heads and necks of ribs.
From here:
- Axillary nodes drain into the subclavian trunks
- Parasternal nodes drain into the bronchomediastinal trunks
- Intercostal nodes drain either into the thoracic duct or into the bronchomediastinal trunks
![By Henry Vandyke Carter [Public domain], via Wikimedia Commons](https://mrcemsuccess.com/wp-content/uploads/2016/12/Breast-Lymph.png)
Lymphatic Drainage of the Breast. (Image by Henry Vandyke Carter [Public domain], via Wikimedia Commons)
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- Biochemistry
- Blood Gases
- Haematology
| Biochemistry | Normal Value |
|---|---|
| Sodium | 135 – 145 mmol/l |
| Potassium | 3.0 – 4.5 mmol/l |
| Urea | 2.5 – 7.5 mmol/l |
| Glucose | 3.5 – 5.0 mmol/l |
| Creatinine | 35 – 135 μmol/l |
| Alanine Aminotransferase (ALT) | 5 – 35 U/l |
| Gamma-glutamyl Transferase (GGT) | < 65 U/l |
| Alkaline Phosphatase (ALP) | 30 – 135 U/l |
| Aspartate Aminotransferase (AST) | < 40 U/l |
| Total Protein | 60 – 80 g/l |
| Albumin | 35 – 50 g/l |
| Globulin | 2.4 – 3.5 g/dl |
| Amylase | < 70 U/l |
| Total Bilirubin | 3 – 17 μmol/l |
| Calcium | 2.1 – 2.5 mmol/l |
| Chloride | 95 – 105 mmol/l |
| Phosphate | 0.8 – 1.4 mmol/l |
| Haematology | Normal Value |
|---|---|
| Haemoglobin | 11.5 – 16.6 g/dl |
| White Blood Cells | 4.0 – 11.0 x 109/l |
| Platelets | 150 – 450 x 109/l |
| MCV | 80 – 96 fl |
| MCHC | 32 – 36 g/dl |
| Neutrophils | 2.0 – 7.5 x 109/l |
| Lymphocytes | 1.5 – 4.0 x 109/l |
| Monocytes | 0.3 – 1.0 x 109/l |
| Eosinophils | 0.1 – 0.5 x 109/l |
| Basophils | < 0.2 x 109/l |
| Reticulocytes | < 2% |
| Haematocrit | 0.35 – 0.49 |
| Red Cell Distribution Width | 11 – 15% |
| Blood Gases | Normal Value |
|---|---|
| pH | 7.35 – 7.45 |
| pO2 | 11 – 14 kPa |
| pCO2 | 4.5 – 6.0 kPa |
| Base Excess | -2 – +2 mmol/l |
| Bicarbonate | 24 – 30 mmol/l |
| Lactate | < 2 mmol/l |
