“Level Three Nodal Involvement in Patients With Early Breast Cancer –A Cross Sectional Study From a Tertiary Care Institution in Kerala”

Background Breast cancer is the most common cancer among humans. The mainstay of breast cancer treatment includes surgery followed by chemotherapy radiotherapy and targeted therapy. Aggressive axillary surgery increase morbidity and reduce the quality of life in terms of lymphedema which affects 20% of those who undergo axillary dissection2.The most important predictor for decreased survival and recurrence in patients with early breast cancer is the presence of axillary lymph node metastases. Axillary nodal involvement in breast cancer is unpredictable but once involved it starts from level 1and follow systematic order from level 1 to 2 to 3. Objectives 1. To find the proportion of patients who turn out to have positive level three axillary nodal metastasis following axillary dissection for early breast cancer 2. To find out factors associated with level 3 node involvement in early breast cancer. Methods Data was collected from 77 patients with early breast cancer. Axillary level 3 nodes were labelled separately during breast surgery and send to pathology for HPE and ER PR and her2neu status and results recorded. Results And Discussion Out of the 77 patients studied 3 of them turned out positive for level 3 nodal disease, even though 40 percent of patients were having clinically palpable nodes in the axilla. ConclusionAmong 77 patients with early Breast cancer 3 (4 percent) were having level 3 nodal disease and the rest of them, 74 (96 percent) were free of level 3 nodal disease. Hence avoiding aggressive axillary dissection and limiting to levels 1 and 2 in EBC will be beneficial in preventing morbidity and for better quality of life.