Association of Level III Axillary Lymph Node Positivity with Clinicopathological Characteristics in Breast Cancer

Management of breast cancer has gradually shifted from era of radical surgery to present days of multi-modality management and conservatism. While complete axillary dissection is common for node-positive cases, less invasive approaches like sentinel node biopsy are often sufficient for clinically node-negative cases. However, these findings may not apply to all populations, particularly in India where advanced disease presentation is common. The objective of this study is to assess Level III Axillary Lymph Node Positivity with clinicopathological characteristics in Breast cancer. This was a hospital based retrospective observational study on breast cancer patients conducted in single institute from 2016 to 2022. A total of 70 patients with operable breast cancers, who underwent primary tumour resection and complete axillary lymph node dissection, including level III were included in the study. Patients with inoperable and metastatic disease were excluded. Final histopathological examination data was collected and analysed. Most patients (92.9%) underwent Modified Radical Mastectomy, with Infiltrating Ductal Carcinoma (IDC) being the most common histology (90%). Factors significantly associated with level III lymph node positivity included tumour size >4.5cm, nuclear grade III, pathological N3 stage and extra nodal extension. The study found no significant correlation with other factors like age, tumour laterality, location, hormone receptor status, HER2 status, or LVSI. These findings may help predict level III lymph node involvement in breast cancer patients. All these predictive factors should be considered during the axillary dissection.