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# Interpectoral nodes

The interpectoral nodes are a small group of lymph nodes between the two [chest](https://durgical.com/en/anatomy/region/chest/) muscles (pectoralis major and minor); breast cancer can spread to them.

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## What it is

A few nodes between pectoralis major and pectoralis minor (level II).

## What it does

Drain part of the upper breast straight to the central and apical nodes, skipping the anterior group.

## Key points

- Rotter nodes: a small group between the pectoralis major and minor, along the pectoral branches of the thoracoacromial artery and the lateral pectoral nerve
- They can receive breast lymph directly and carry metastases that bypass the lower axillary levels
- Cannot be felt on examination and are seldom the sentinel node; they are assessed by imaging or found at surgery

## Key facts

**Where**
Between pectoralis major and pectoralis minor (Rotter's nodes)

**Drains**
Upper breast and pectoral region

**Into**
[Apical axillary nodes](https://durgical.com/en/anatomy/apical-axillary-nodes/)

## Relations

**In front**
Deep surface of the [pectoralis major](https://durgical.com/en/anatomy/pectoralis-major-muscle/)

**Behind**
[Pectoralis minor](https://durgical.com/en/anatomy/pectoralis-minor-muscle/) and its fascia (clavipectoral fascia)

**Contents**
A few nodes in fat with the pectoral branches of the [thoracoacromial artery](https://durgical.com/en/anatomy/thoracoacromial-artery/) and the lateral pectoral nerve

**Above**
Apical axillary lymph nodes and the infraclavicular region

## How to find it

Not palpable. In surgery they are found by lifting the pectoralis major off the pectoralis minor; on imaging they are sought in the fat plane between the two muscles.

## On imaging

CT, MRI or PET-CT can show an enlarged node in the plane between the pectoral muscles; ultrasound reaches it in some patients.

## Common problems

- Can hold breast cancer even when the lower axillary nodes are clear.

## 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

- Grouped with level II nodes in many surgical systems (level I lateral, level II behind and level III medial to pectoralis minor); some texts list them separately
- Removing them puts the [medial and lateral pectoral nerves](https://durgical.com/en/anatomy/medial-and-lateral-pectoral-nerves/) at risk; injury weakens and wastes the pectoralis major
- Breast cancer in men follows the same lymph pathways, including these nodes
- After mastectomy, involved nodes left between the pectoral muscles are a recognised site of regional recurrence, which may appear as a lump under the pectoralis major

## Anatomical variants

- Not found in every person, and their number varies when present; some surgical series find none on careful dissection

## Test yourself

Think of the answer, then tap the question to see it.

## Where do the interpectoral (Rotter) nodes lie?

Between the pectoralis major and minor, along the pectoral branches of the thoracoacromial artery and the lateral pectoral nerve.

## Why do interpectoral nodes matter in breast cancer?

They can receive breast lymph directly and carry metastases that bypass the lower axillary levels.

## Which nerves are at risk when interpectoral nodes are removed, and with what result?

The medial and lateral pectoral nerves; injury weakens and wastes the pectoralis major.

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## Its names

**Official Latin (TA2)**
nodi interpectorales TA2 5242

**Official Spanish (DeCS)**
Nódulos linfáticos interpectorales

**English (TA2)**
Interpectoral nodes

**Also called**
Rotter's nodes

## Related

- [Pectoralis minor](https://durgical.com/en/anatomy/pectoralis-minor-muscle/)
- [Pectoralis major](https://durgical.com/en/anatomy/pectoralis-major-muscle/)

Sources: Terminologia Anatomica (TA2); [Anatomy, Thorax: Mammary Gland](https://www.ncbi.nlm.nih.gov/books/NBK547666/); [Anatomy, Shoulder and Upper Limb, Axillary Lymph Nodes](https://www.ncbi.nlm.nih.gov/books/NBK559188/).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/anatomy/interpectoral-nodes/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/anatomy/interpectoral-nodes/