Lymph Node Status and Staging
Lymph node status shows whether or not the lymph nodes in the underarm area (axillary lymph nodes) contain cancer:
- Lymph node-negative means none of the axillary lymph nodes contain cancer.
- Lymph node-positive means at least one axillary lymph node contains cancer.
Prognosis (chance of survival) is better when cancer has not spread to the lymph nodes (lymph node-negative) [12].
The more lymph nodes that contain cancer, the poorer prognosis tends to be [12].
The number of positive nodes guides treatment and helps predict prognosis.
The following is a 3D interactive model showing parts of the breast and the axillary lymph nodes.
Learn more about lymph node status.
Pathologic lymph node status
A pathology exam is the best way to assess lymph node status. This is called pathologic lymph node status.
Usually, a surgeon removes one or more axillary lymph nodes with a technique called sentinel node biopsy. A pathologist studies these nodes under a microscope to see if they contain cancer.
These results help determine breast cancer stage and guide treatment.
Learn more about sentinel node biopsy and assessing lymph nodes.
Clinical lymph node status
A physical exam (also called a clinical exam) can give a first estimate of lymph node status. This is called clinical lymph node status. Enlarged nodes can be a sign the breast cancer has spread to the nodes.
Clinical lymph node status is only used when pathologic findings aren’t available.
Lymph node status categories
See Figure 4.4 for a drawing of the breast and lymph nodes.
Pathologic lymph node status |
Clinical lymph node status |
|
NX |
Axillary and other nearby lymph nodes cannot be assessed (for example, they were not removed during surgery) |
Axillary and other nearby lymph nodes cannot be assessed (for example, they were removed in the past) |
N0 |
Axillary and other nearby lymph nodes don’t have cancer or only have isolated tumor cells (individual cancer cells), when looked at under a microscope |
Axillary and other nearby lymph nodes don’t have cancer |
N1 |
Micrometastases (very small clusters of cancer cells) OR 1–3 axillary lymph nodes have cancer AND/OR Internal mammary nodes have cancer or micrometastases found on sentinel node biopsy |
Axillary lymph nodes have cancer, but can be moved around |
N2 |
4–9 axillary lymph nodes have cancer OR Internal mammary nodes have cancer, but axillary lymph nodes don’t have cancer |
Axillary lymph nodes have cancer and are matted together or fixed to other structures (such as the chest wall) OR Internal mammary nodes have cancer, but axillary lymph nodes don’t appear to have cancer |
N3 |
10 or more axillary lymph nodes have cancer OR Infraclavicular (under the clavicle) nodes have cancer OR Internal mammary nodes have cancer plus 1 or more axillary lymph nodes have cancer OR 4 or more axillary lymph nodes have cancer plus internal mammary nodes have cancer or micrometastases (very small clusters of cancer cells) found on sentinel node biopsy OR Supraclavicular (above the clavicle) nodes have cancer |
Infraclavicular (under the clavicle) nodes have cancer (axillary lymph nodes may or may not have cancer) OR Internal mammary nodes and axillary lymph nodes have cancer OR Supraclavicular (above the clavicle) nodes have cancer (axillary lymph nodes may or may not have cancer) |
Adapted from American Joint Committee on Cancer materials [30]. |
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Updated 12/20/22
