Normal interpectoral nodes (ultrasound)

Case contributed by Dr Giorgio M Baratelli

Presentation

Screening breast ultrasound.

Patient Data

Age: 40
Gender: Female
Ultrasound

The round hypoechoic images (arrows) are normal interpectoral node along the pectoral branches of the thoracoacromial vessels (highlighted by Color Doppler).

Case Discussion

Interpectoral nodes (Rotter's node) are located between the pectoralis major and minor muscles in the interpectoral fascia along the pectoral branches of the thoracoacromial vessels. Sometimes the interpectoral nodes can be seen on ultrasound, even when not enlarged.

These nodes may represent the site of primary drainage from tumors of the upper quadrants in a small percentage of patients. In these cases, they could be sentinel lymph nodes, identified with lymphoscintigraphy.

Two practical considerations:

  1. If metastatic without the involvement of level I nodes it could explain the so-called "skip metastases" phenomenon.
  2. They could be the site of recurrence (interpectoral node recurrence), even in node-negative patients at the original operation, because they are not routinely removed in the level I and II axillary dissection.

Interpectoral nodes exploration should be mandatory during preoperative and follow-up ultrasound evaluation in breast cancer patients.

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