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Axillary lymph nodes

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Lymph vessels and nodes of the female breast.

The axillary lymph nodes are a collection of 5 groups of lymph nodes found in the axillary region of the upper limb. The axillary region is commonly referred to as the ‘armpit’, although it is a three-dimensional, pyramidal space which changes shape based upon whether the arm is adducted or abducted.

The axillary lymph nodes have a particular clinical relevance due to their arrangement and drainage areas. This is particularly evident in breast cancer, where axillary lymph node status defines the treatment algorithm and approach.

In this article we will discuss the anatomy and function of the axillary lymph nodes. In addition, we will discuss function and clinical relevance. 

Key facts about the axillary lymph nodes
Definition A collection of 5 groups of lymph nodes found in the axillary region of the upper limb
Classification Lateral, anterior (pectoral), pos­terior (subscapular), central and apical groups.
Drainage areas Upper limb, breast and trunk above the umbilicus
Contents
  1. Location and function
    1. Anterior group
    2. Posterior group
    3. Lateral group
    4. Central group
    5. Apical group
  2. Infraclavicular group
  3. Thoracic duct
  4. Clinical points
    1. Breast cancer
    2. Virchow’s node
    3. Lymphoma
  5. Sources
+ Show all

Location and function

The axillary lymph nodes are located within the axillary region of the upper limb. There are approximately 20 to 30 (up to 40 have been noted) individual axillary lymph nodes which are divided into 5 groups.

  • Lateral
  • Anterior (pectoral)
  • Pos­terior (subscapular)
  • Central
  • Apical

The axillary lymph nodes serve to drain the entire upper limb, the breast, and the trunk above the umbilicus. Lymph flow is similar to venous blood flow. Lymph is conveyed from the periphery towards the heart.

Anterior group

The anterior group of the axillary lymph nodes is also known as the pectoral group. They can be located across the inferior border of the pectoralis minor muscle and the superior border of the pectoralis major muscle. There are usually 4-5 large nodes.

These lymph nodes drain the skin and muscles of the anterolateral aspect of the abdominal wall superior to the level of the umbilicus and the lateral quadrants of the breast. It coveys the lymph to more central nodes and partly to the apical axillary nodes.

Posterior group

The posterior group of the axillary lymph nodes is also known as the subscapular group. This group consists of 6-7 nodes that can be found anterior to the subscapularis muscle

The posterior group drains the skin and muscles of the posterior neck and the upper back back. However, these lymph nodes often drain the back as far inferior as the superior border of the iliac crests.

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Lateral group

The lateral group of axillary lymph nodes consists of 4-6 nodes that can be found posteromedial to the axillary vein. The vast majority of the lymph vessels from the upper limb drained into this group. The only exception are the lymph vessels that accompany the cephalic vein which drain the lateral aspect of the upper limb and flow into the infraclavicular nodes.

Central group

The central group of axillary lymph nodes consists of 3-4 nodes. These nodes are found at the base and center of the axilla, interspersed amongst the adipose tissue of the region.

The central group is the most important group of nodes in terms of drainage because these receive lymph from all the three groups of nodes mentioned above (anterior, posterior, and lateral).

Apical group

The apical group of axillary lymph is also referred to as the subclavicular group. This group consists of 4-5 nodes that lie at the lateral border of the first rib, extending to the apex of the axilla medial to the axillary vein.

This group receives efferent lymph vessels from the other axillary group of nodes. The apical group of nodes then drains into the subclavian lymph trunk.

The drainage is different on the left and right sides. The nodes on the left side drain into the thoracic duct, whereas on the right side the nodes drain into the right lymphatic trunk.

Infraclavicular group

The infraclavicular nodes cannot be referred to as axillary lymph nodes as they are located outside the axillary fossa and the axillary region. However, they do form a close relation to the axillary group and lie in the deltopectoral groove (muscular superficial space between the deltoid and the pectoralis major).

This space is also where the cephalic vein passes. In addition to this, this lymph node group of 2-3 nodes drains the major muscles of the forearm, hand, and arm, as well as the superficial lymph vessels of surrounding regions.

Test your knowledge on the lymphatics of the female breast with this quiz.

Thoracic duct

The thoracic duct is the main lymphatic duct of the body. It conveys the lymph from the lower limbs, abdomen, and the left side of trunk, upper limb, neck, and face.

A portion of the thoracic duct in the abdomen is a dilated sac referred to as the cisterna chyli or milk tank. This is because it contains the lymph fluid from the intestines, which is rich in chyle. This chyle is formed by fatty molecules (emulsified fats) and lymph from the lacteals. It is different from the lymph vessels that drain the limbs, where the drainage is purely lymph, and therefore clearer.

The thoracic duct is typically around 40 cm in length and has a diameter of 3-5 millimeters. The drainage of the thoracic duct is into the junction of the left jugulars and left subclavian vein. It is here that the lymphatic drainage of the bowels and body enters the systemic circulation. The drainage of the right upper limb, thorax, head, and neck drains into the right lymphatic duct.

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