Apical axillary nodes

At a glance

English

Apical axillary nodes

Latin (TA2)

Nodi axillares apicales

System

Lymphatic

Region

Whole body

Side

Paired, left and right

About the apical axillary nodes

The apical nodes, also called the subclavicular nodes, occupy the top of the axilla, the narrow apex that leads up into the root of the neck between the clavicle, the first rib and the upper border of the scapula. They lie along the last part of the axillary vein, some behind the upper portion of pectoralis minor and some above its upper edge, beneath the clavipectoral fascia. The group is fairly large, commonly numbering between six and twelve nodes.

They are the final common station of the axilla. The anterior, lateral and posterior groups pass their lymph to the central nodes, and the central nodes in turn send it up to the apical nodes, so nearly all lymph leaving the armpit passes through them. In addition they take a few vessels directly: those that travel with the cephalic vein from the outer side of the arm, after passing the infraclavicular nodes, and some from the upper part of the breast.

Their efferent vessels join to form the subclavian lymph trunk. On the right this trunk empties at the venous angle, where the subclavian vein meets the internal jugular, either on its own or by way of the right lymphatic duct or the jugular trunk; on the left it often joins the thoracic duct instead. Some vessels also reach the lower deep cervical nodes above the clavicle.

In breast cancer these are the highest axillary nodes, and disease reaching them suggests advanced spread through the armpit. Surgeons describe them as the third level of the axilla, above and medial to pectoralis minor. Because they connect with the deep cervical nodes, cancer here may go on to the supraclavicular region. Clearing them risks the axillary vein and the nerves to the pectoral muscles.

Course and drainage

Begins at

Afferent vessels from all the other axillary groups via the central nodes, plus direct vessels along the cephalic vein and from the upper part of the breast.

Drains into

Efferent vessels form the subclavian lymph trunk, ending at the venous angle of the neck or, on the left, often in the thoracic duct; some go to the inferior deep cervical nodes.

Drains

The last filter for lymph leaving the axilla, gathering the upper limb, chest wall and breast. Cancer here marks advanced axillary spread and may continue to the neck.