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200
38

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Anatomy

Upper Limb

Question 41 of 239

A 43 year old woman has presented to the ED in distress. She tells you she has found a new lump in her left breast. She is new to the area and has not registered with a GP, she is concerned about breast cancer and is seeking advice. As part of your examination you check for lymphadenopathy. Which of the following groups of lymph nodes receive the majority of lymph from breast tissue:

Answer:

Approximately 75% of lymph drainage from the breast is via lymphatic vessels that drain laterally and superiorly into axillary nodes.

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

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

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