The Axilla and Operative Anatomy
This vessel forms the superior boundary of the axilla and lies just inferior to the axillary artery and brachial plexus.
What is the axillary vein
This procedure identifies the first draining lymph node from a breast tumor using techniques such as blue dye, radiotracer, or both.
What is a sentinel lymph node biopsy?
These two visual findings guide blue-dye–based sentinel node retrieval.
What are blue lymphatic channels and blue lymph nodes?
ALND removes these lymph node levels during standard dissection in breast cancer.
What are levels I and II?
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These muscles form the lateral and medial borders of the axilla.
What are the latissimus dorsi and serratus anterior?
During this operation—once standard for all node-positive disease—the long thoracic nerve must be preserved to avoid postoperative “winged scapula.”
What is an axillary lymph node dissection?
During SLNB with technetium, all nodes with counts greater than this percentage of the hottest node must be removed.
What is 10%?
This incision, shaped like the name suggests, is traditionally used for ALND.
What is a "Lazy S" incision
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The long thoracic nerve must be preserved in SLNB and ALND to prevent this functional complication.
What is a winged scapula
This management strategy allows select patients with 1–2 positive sentinel nodes to avoid full axillary dissection when undergoing breast-conserving surgery with radiation, following evidence from the ACOSOG Z0011 trial.
What is omission of completion axillary dissection?
Failure to identify a sentinel node intraoperatively requires this next step.
What is axillary lymph node dissection (ALND)?
This sensory nerve is often sacrificed during ALND, leading to numbness of the axilla and medial upper arm.
What is the intercostobrachial nerve?
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This muscle defines levels I, II, and III during axillary dissection.
This technique involves placing a clip in a biopsied, node-positive axillary lymph node and later selectively removing that node during surgery after neoadjuvant chemotherapy.
What is targeted axillary dissection?
These microscopic nodal findings (<0.2 mm or <200 cells) classify the axilla as N0 and do not warrant further axillary surgery.
What are isolated tumor cells?
For patients undergoing breast-conserving surgery, completion ALND is recommended in the presence of this number of positive sentinel nodes or gross extranodal extension.
What is more than two positive sentinel nodes?
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The thoracodorsal nerve travels with its artery/vein and lies medial to this landmark muscle.
What is latissimus dorsi
This structure, the superficial continuation of the axillary vein, is a key landmark that defines the superior boundary of level I and II node dissections and must be protected during ALND.
What is the axillary vein?
This clinical subtype of breast cancer always undergoes SLNB after neoadjuvant therapy and cannot be staged with SLNB upfront.
What is inflammatory breast cancer?
•In patients presenting with biopsy-proven node-positive breast cancer who complete neoadjuvant chemotherapy, the accuracy of sentinel lymph node biopsy dramatically improves when THREE specific technical conditions are met. These conditions reduce the false-negative rate to approximately 10% or lower, forming the basis of the modern 'targeted axillary dissection' paradigm.
• Name all THREE required components
•1. Dual tracer mapping (radioisotope + blue dye)
•2. Retrieval of at least 2–3 sentinel lymph nodes
•3. Successful localization and removal of the clipped node (targeted node).
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