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Localization of the Sentinel Node of the Upper Outer Breast Quadrant in the Axillary Quadrants

¹ Department of Oncogynecology, Clinic of Obstetrics and Gynecology, 1st Medical Faculty, Charles University, and General Faculty Hospital, Apolinarska 18, Prague, 12801, Czech Republic
² Institute of Anatomy, 1st Medical Faculty, Charles University, Prague, Czech Republic
³ Department of Plastic Surgery, 3rd Medical Faculty, Charles University, Srobarova 50, Prague 10034, Czech Republic

Correspondence: Address correspondence and reprint requests to: David Pavlista, MD; E-mail: d.pavlista{at}seznam.cz

Background: Sentinel node (SN) biopsy is associated with much less morbidity than axillary dissection. In patients with early breast cancer, lymphatic mapping and SN biopsy accurately stage the axillary nodes. Both currently available lymphatic mapping agents, radiocolloid and blue dye, have some limitations that may make perioperative or preoperative SN identification difficult. In such cases, exact knowledge of the topography of the axilla and the most probable location of the SN may be crucial.

Methods: In 12 fresh female cadavers with no history of breast carcinoma, injections of patent blue dye were used to visualize the SNs in the axillary quadrants and their lymphatic collectors from the upper outer quadrant of the breast, which is the most common location of breast cancer. The axilla was divided into quadrants with regard to the intersection of the thoracoepigastric vein and the third intercostobrachial nerve.

Results: All SNs were located within a circle of 2-cm radius of this intersection in the fatty tissue at the clavipectoral fascia. In most cases, the SN was located in the fatty tissue near the clavipectoral fascia in the lower ventral quadrant of the axilla (n = 14, 58%). In seven cases (29%), the SN was located in the upper ventral quadrant, in two cases (8%) in the upper dorsal quadrant, and in one case in the lower dorsal quadrant.

Conclusions: The results of this anatomical study may facilitate SN biopsy in patients with breast cancer.

Key Words: Breast cancer • Cadaver model • Lymphatic mapping • Sentinel node