The 35-year-old female patient has a hard nodule about 1 cm in diameter slightly above and lateral to her right areola. A specific dye is injected into the tissue around the tumor, and an incision is made to expose the lymphatic vessels draining the area, for the lymphatic vessels take up the dye-which is visible to the eye. The vessels can then be traced to surgically expose the lymph nodes receiving the lymph from the tumor. Which of the following nodes will most likely first encounter the lymph from the tumor?
High-Yield Explanation
The anterior axillary (or anterior pectoral) nodes are the first lymph nodes to receive most of the lymph from the breast parenchyma, areola, and nipple. From there, lymph flows through central axillary, apical, and supraclavicular nodes in sequence. Rotter's nodes lie between the pectoral muscles and are, unfortunately, an alternate route in some patients, speeding the rate of metastasis. The parasternal nodes receive lymph from the medial part of the breast and lie along the internal thoracic artery and vein.