Regional lymph nodes for lung cancer staging are named according to the structures with which they are most closely related or their general anatomic location. The IASLC lymph node map defines 14 different lymph node stations, which may be grouped into seven zones.
Thoracic lymph node map - IASLC 2009
- 1. Low cervical, supraclavicular and sternal notch nodes: From the lower margin of the cricoid to the clavicles and the upper border of the manubrium. The midline of the trachea serves as border between 1R and 1L.
Superior Mediastinal Nodes 2-4
- 2R. Upper Paratracheal: 2R nodes extend to the left lateral border of the trachea. From upper border of manubrium to the intersection of caudal margin of innominate (left brachiocephalic) vein with the trachea.
- 2L. Upper Paratracheal: From the upper border of manubrium to the superior border of aortic arch.2L nodes are located to the left of the left lateral border of the trachea.
- 3A. Pre-vascular: anterior to the vessels.
- 3P. Pre-vertebral: behind the esophagus
- 4R. Lower Paratracheal: From the intersection of the caudal margin of innominate (left brachiocephalic) vein with the trachea to the lower border of the azygos vein. 4R nodes extend from the right to the left lateral border of the trachea.
- 4L. Lower Paratracheal: from the upper margin of the aortic arch to the upper rim of the left main pulmonary artery.
Aortic Nodes 5-6
- 5. Subaortic: These nodes are located in the AP window lateral to the ligamentum arteriosum.
- 6. Para-aortic: These are ascending aorta or phrenic nodes lying anterior and lateral to the ascending aorta and the aortic arch.
Inferior Mediastinal Nodes 7-9
- 7. Subcarinal
- 8. Paraesophageal: Nodes below carina.
- 9R or 9L. Pulmonary Ligament: Nodes lying within the pulmonary ligaments.
Hilar, Lobar and (sub)segmental Nodes 10-14
Text by Antoine Micheau, MD - Copyright IMAIOS
- 10R or 10L. Hilar nodes: These include nodes adjacent to the main stem bronchus and hilar vessels. On the right they extend from the lower rim of the azygos vein to the interlobar region. On the left from the upper rim of the pulmonary artery to the interlobar region.