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Axillary levels I to III

Local vessels and regional nodes · detail · Pectoralis minor

Berg's surgical levels are defined entirely by pectoralis minor: level I lies lateral and inferior to it, level II behind it, and level III medial to it at the apex. Standard clearance takes levels I and II.

Traced from the start

  1. Breast
  2. Axillary levels I to III

Detail

Level I
Lateral and inferior to pectoralis minor
Level II
Deep to pectoralis minor; includes interpectoral (Rotter's) nodes
Level III
Medial to pectoralis minor, apical/infraclavicular
Standard clearance
Levels I and II
Adequate specimen
At least 10 nodes examined for staging

When it goes wrong

Skip metastasis through Rotter's nodes

Level III disease with negative level I and II nodes

Extending clearance to level III

Higher rate of arm lymphoedema for little staging gain

Practise this structure

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