Central group (Nodi lymphoidei centrales)
The central group of lymph nodes occupies a median position in the architecture of the axillary region. Among all the axillary nodes under consideration, it is the central ones that stand out for their prominent dimensions—they are the largest.
Regarding their exact topographical localization, they are situated directly in the very center of the base of the axillary fossa. An important anatomical detail is that these lymph nodes are securely hidden beneath the layer of the deep fascia (fascia propria). Furthermore, their position is inextricably linked with the major blood vessels: they line up in a peculiar chain along the course of the axillary vein, which requires utmost concentration and caution from the surgeon when isolating vessels during surgical interventions.
Posterior and lateral node groups
The anatomy of the axillary fossa includes nodes responsible for draining the back and upper extremity. They are conventionally divided into two independent groups depending on their location relative to the walls of the cavity:
- Subscapular, or posterior nodes (Nodi lymphoidei subscapulares / posteriores). This group has a clear spatial reference: the nodes are localized along the course of the subscapular vessels. Their area of responsibility includes collecting lymph from the dorsal regions of the body. In particular, they receive lymphatic fluid from the anatomical structures of the upper back as well as from the posterior surface of the neck.
- Humeral, or lateral nodes (Nodi lymphoidei humerales / laterales). These formations are located near the very lateral wall of the axillary cavity. The neurovascular bundle acts as the most important topographical landmark here—the nodes lie strictly medial to it. The main function of this group is to collect lymph exclusively from the tissues of the upper extremity.
Anterior group and Zorgius' node
The pectoral, or anterior, group of nodes (Nodi lymphoidei pectorales / anteriores) is of immense clinical significance. Topographically, these structures lie on the surface of the serratus anterior muscle, and the course of the lateral thoracic artery (a. thoracica lateralis) serves as a landmark for the surgeon to find them. The territory from which they collect lymph is quite extensive. Fluid drains here from the anterolateral surface of the chest and abdomen (with the strict lower boundary of collection being the level above the umbilicus). The most important aspect is that lymph from the breast is directed precisely here.
Special attention is deserved by Zorgius' node. This can be either a single lymph node or several isolated lymph nodes of the anterior group. Its exact localization is the level of the 3rd rib directly beneath the edge of the pectoralis major muscle (m. pectoralis major). In clinical oncology, Zorgius' node is known for being the most common site of initial metastasis in the development of breast cancer, which is why its targeted detection is mandatory.
Briefly: answers to topical questions
What groups of axillary lymph nodes exist in addition to the anterior, posterior, lateral, and central ones?
In addition to the anterior (nodi lymphoidei pectorales), posterior (nodi lymphoidei subscapulares), lateral (nodi lymphoidei humerales), and central (nodi lymphoidei centrales) groups, there is a fifth group of lymph nodes in the axillary fossa.
- Apical group (nodi lymphatici apicales) is located directly at the apex of the axillary pyramid (apex).
Where do the efferent lymphatic vessels from the central group of axillary nodes drain?
Efferent lymphatic vessels from all axillary nodes, including the central group, form the axillary lymphatic plexus (plexus lymphaticus axillaris), which runs along the course of the axillary and subclavian veins. The right and left subclavian trunks (trunci subclavii dexter et sinister) are formed from the efferent vessels of this plexus.
Where are the apical axillary lymph nodes topographically located?
Topographically, the apical axillary lymph nodes are located at the apex of the axillary pyramid (apex).
Their localization includes the following landmarks:
- At the medial margin of the axillary vein (v. axillaris).
- Medial to the pectoralis minor muscle, where they belong to level III of the axillary lymph nodes.
Imagine a person hugging a tree trunk: the anterior nodes face the trunk (chest, abdomen), the posterior ones face the back, the lateral ones lie on the arms themselves, and the largest central ones hide deep within the base of the axilla.
Class and exam questions
Where exactly is Zorgius' node located?
It is located at the level of the 3rd rib, situated beneath the edge of the pectoralis major muscle (m. pectoralis major).
Which nodes are the first to be affected by metastases in breast cancer?
Most commonly, the nodes of the anterior (pectoral) group are affected first, specifically Zorgius' node.
Where does lymph from the upper extremity drain?
Lymph from the upper extremity is collected into the humeral (lateral) lymph nodes located near the lateral wall of the axillary cavity.
What is the topographical feature of the central nodes?
They are the largest, lie in the center of the base of the axillary fossa beneath the deep fascia, and are positioned along the axillary vein.
What else to study on this topic
- Topography of the axillary vein and neurovascular bundle
- Course and branching of the lateral thoracic artery
- Anatomy of the pectoralis major and serratus anterior muscles
- Structure of the axillary cavity walls (anterior, posterior, medial, lateral)
- Deep fascia of the axillary fossa
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