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In a consecutive series of 73 patients undergoing a level III axillary clearance, interpectoral nodes were sought and, if palpable, excised. 18 interpectoral nodes were identified in 15 patients, 10 (14%) of whom had involved and 5 of whom had uninvolved interpectoral nodes. 7 of the 10 patients with involved interpectoral nodes also had axillary node involvement, but 3 patients had positive interpectoral nodes in the absence of involved axillary nodes. A comparison of patient and tumour characteristics in the groups of patients with and without interpectoral node involvement showed that patients who had involved interpectoral nodes were significantly younger and had significantly larger tumours. Interpectoral node involvement by breast cancer is not uncommon and these nodes can be involved in the absence of axillary nodal involvement. They should be looked for, and if identified, excised during axillary clearance.

From June to December 1990, 110 consecutive patients with breast cancer underwent a modified radical mastectomy (n=33) or quadrantectomy (n=77) combined with a complete axillary dissection and removal or interpectoral lymphatic tissue. The average number of lymph nodes removed from the axilla and interpectoral region was 22: 12.5 at Level I, 6.4 at Level II, 3.7 at Level III and 1.5 from the interpectoral tissue. In 59 110 patients fatty tissue only was found in the interpectoral region and in the remaining 51 patients, interpectoral lymph nodes were identified and these were involved in 22 patients (37.3% of total group). In 3 patients these were the only nodes involved. During axillary dissection the interpectoral space should be explored and palpable interpectoral nodes removed and submitted for histology.