[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Anatomy](https://durgical.com/en/anatomy/) › [Upper limb](https://durgical.com/en/anatomy/region/upper-limb/) › Apical axillary nodes [Lymphatic system](https://durgical.com/en/anatomy/system/lymphatic-system/) · [Upper limb](https://durgical.com/en/anatomy/region/upper-limb/) # Apical axillary nodes The apical axillary nodes sit at the top of the armpit under the collarbone; all the lymph of the arm and much of the breast passes through them. [See in 3D →](https://durgical.app/?from=durgipedia&lang=en#region=upper_limb&select=axillary_nodes_apical&side=r) Opens in the Durgical app, no sign-up needed. ## What it is Nodes at the apex of the armpit, above and medial to pectoralis minor, along the axillary vein (level III). ## What it does Receive all the other axillary groups (and the [infraclavicular nodes](https://durgical.com/en/anatomy/infraclavicular-nodes/)); their outflow forms the subclavian lymph trunk. ## Key points - At the apex of the axilla, medial to [pectoralis minor](https://durgical.com/en/anatomy/pectoralis-minor-muscle/), in front of and medial to the axillary vein, behind the clavipectoral fascia, near the first intercostal space (level III) - In breast cancer, involvement of these nodes (the infraclavicular station of staging) means more advanced regional disease and can spread on to the supraclavicular nodes ## Key facts **Where** Apex of the axilla, medial and superior to pectoralis minor, along the axillary vein (level III) **Drains** All other axillary groups; infraclavicular nodes; upper breast **Into** Subclavian lymph trunk -> thoracic duct (left) or right lymphatic duct / venous angle ## Relations **Course** Efferents join into the subclavian lymph trunk, which runs with the [subclavian vein](https://durgical.com/en/anatomy/subclavian-veins/) to the junction of the internal jugular and subclavian veins (right) or to the [thoracic duct](https://durgical.com/en/anatomy/thoracic-duct/) (left) **In front** Clavipectoral fascia and [pectoralis major](https://durgical.com/en/anatomy/pectoralis-major-muscle/); the end of the [cephalic vein](https://durgical.com/en/anatomy/cephalic-vein/), the thoracoacromial vessels and the lateral pectoral nerve cross this plane **Lateral** The [axillary vein](https://durgical.com/en/anatomy/axillary-vein/), then the [axillary artery](https://durgical.com/en/anatomy/axillary-artery/) and the cords of the [brachial plexus](https://durgical.com/en/anatomy/roots-of-brachial-plexus/) **Medial** The first intercostal space and the first digitation of [serratus anterior](https://durgical.com/en/anatomy/serratus-anterior/) **Above** [Clavicle](https://durgical.com/en/anatomy/clavicle/) and [subclavius](https://durgical.com/en/anatomy/subclavius/); beyond them, the supraclavicular nodes at the root of the neck ## How to find it Usually not palpable. With the arm relaxed, the examiner pushes the fingertips as high as possible into the axilla toward the clavicle; ultrasound, CT or PET-CT assess them for staging. ## Common problems - Cancer here (level III) is more advanced and can spread on to the nodes above the clavicle. ## How it is diagnosed Examination of the armpit and ultrasound with a needle biopsy; in breast cancer, the sentinel node is found with a tracer during surgery. ## Treatment - Sentinel node biopsy: only the first one to three nodes are removed and checked. - Axillary dissection (levels I–II) or radiotherapy when the nodes contain cancer; arm swelling (lymphoedema) is the main risk. ## Clinical notes - Level III disease places a breast cancer in a higher nodal stage than involvement of level I or II alone - Surgically hard to reach because of the [pectoral nerves](https://durgical.com/en/anatomy/medial-and-lateral-pectoral-nerves/) and the end of the cephalic vein; clearing them may need pectoralis minor to be retracted or divided - Spread beyond them reaches the supraclavicular nodes, which may then be felt above the clavicle ## Related conditions - [Breast cancer](https://durgical.com/en/conditions/breast-cancer/) ## Test yourself Think of the answer, then tap the question to see it. ## Where are the apical axillary nodes and which surgical level are they? At the apex of the axilla, medial to pectoralis minor and in front of the axillary vein, behind the clavipectoral fascia: level III. ## What vessel do the efferents of the apical nodes form and where does it end? The subclavian lymph trunk, ending in the venous angle on the right or the thoracic duct on the left. ## Why are the apical axillary nodes hard to reach in surgery? They lie high behind pectoralis minor and the clavipectoral fascia, among the pectoral nerves and the end of the cephalic vein. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/anatomy/apical-axillary-nodes/) Educational information, not medical advice. For any symptom, see a health professional. ## Its names **Official Latin (TA2)** nodi axillares apicales TA2 5237 **Official Spanish (DeCS)** Nódulos linfáticos axilares apicales **English (TA2)** Apical axillary nodes **Also called** subclavian nodes ## Related - [Central axillary nodes](https://durgical.com/en/anatomy/central-axillary-nodes/) - [Axillary vein](https://durgical.com/en/anatomy/axillary-vein/) - [Subclavian vein](https://durgical.com/en/anatomy/subclavian-veins/) Sources: Terminologia Anatomica (TA2); Anatomía humana (4.ª ed.), tomo 1, cap. 61: Vasos y ganglios linfáticos del miembro superior; [Anatomy, Shoulder and Upper Limb, Axillary Lymph Nodes](https://www.ncbi.nlm.nih.gov/books/NBK559188/). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/anatomy/apical-axillary-nodes/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/anatomy/apical-axillary-nodes/