Mediastinal staging for NSCLC

Question 1

Lung ca (T-stage)

Answer 1

Question 2

Lung ca (N-stage)

Answer 2

N1: Ipsilateral peribronchial, hilar, intrapulmonary LN

N2: Ipsilateral mediastinal/subcarinal LN

N3:

• Contralateral mediastinal/hilar LN
• Ipsilateral/contraleral scalene or supraclavicluar LN

Question 3

Lung ca (M-stage)

Answer 3

Question 4

AJCC lung cancer staging

Answer 4

Stage I: T1-T2a, N0, M0. ; tumors < 4cm

Stage II:

• T1-2 with N1 disease (MO)
• T2b or T3 alone (NO, MO)

Stage III:

• N2 or N3 disease
• T3 with LN (N1-3)
• T4 alone

Stage IV: M1 disease (M1a or M1b)

Question 5

Answer 5

Question 6

Answer 6

Question 7

Answer 7

Question 8

N3 positive disease

Answer 8

Chemotherapy + radiation

Question 9

N2 Negative

Answer 9

Question 10

Treatment of single-station N2 disease?

Answer 10

Question 11

Treatment of Multistation N2 Disease?

Answer 11

Chemotherapy +/- radiation treatment

Question 12

Thoracic lymph node stations

Stations 1 & 3?

Answer 12

Station 1 (left/right): low cervical, supraclavicular, and sternal notch nodes

Station 3A and 3P: pre-vascular and retrotracheal nodes

Question 13

Thoracic lymph node stations

Stations 2 & 4

Answer 13

Station 2 (left/right): upper paratracheal nodes

Station 4 (left/right): lower paratracheal nodes

Question 14

Thoracic lymph node stations

Station 5 Nodes

Answer 14

Station 5: subaortic nodes (aortopulmonary window)
* lateral to ligamentum arteriosum
* superior border: inferior border of the aortic arch
* inferior border: superior border of the left main pulmonary artery

Question 15

Thoracic lymph node stations

Station 6 Nodes

Answer 15

Station 6: para-aortic nodes, ascending aorta or phrenic
* anterior and lateral to the ascending aorta and aortic arch
* superior border: line tangential to the upper border of the aortic arch
* inferior border: lower border of the aortic arch

Question 16

Thoracic lymph node station

• lateral to ligamentum arteriosum
• superior border: inferior border of the aortic arch
• inferior border: superior border of the left main pulmonary artery

Answer 16

Station 5: subaortic nodes (aortopulmonary window)

Question 17

Thoracic lymph node stations

• anterior and lateral to the ascending aorta and aortic arch
• superior border: line tangential to the upper border of the aortic arch
• inferior border: lower border of the aortic arch

Answer 17

Station 6: para-aortic nodes, ascending aorta or phrenic

Question 18

Thoracic lymph node stations

Station 7 Nodes

Answer 18

Station 7: subcarinal nodes
* superior border: carina
* inferior border - left: upper border of the lower lobe bronchus
* inferior border - right: lower border of bronchus intermedius

Question 19

Thoracic lymph node stations

Stations 8 Nodes

Answer 19

Station 8 (left/right): para-esophageal nodes (below carina)
* superior border: station 7, i.e. upper border of lower lobe bronchus on left, and lower border of bronchus intermedius on right
* inferior border: diaphragm

Question 20

Thoracic lymph node stations

Station 9 Nodes

Answer 20

Station 9 (left/right): pulmonary ligament nodes
* lying within the pulmonary ligament
* superior border: inferior pulmonary vein
* inferior border: diaphragm

Question 21

Thoracic lymph node stations

Station 10 Nodes

Answer 21

Station 10 (left/right): hilar nodes
* immediately adjacent to mainstem bronchus and hilar vessels
* superior border: lower border of the azygos vein on the right, the upper border of the pulmonary artery on the left

Question 22

Thoracic lymph node stations

Station 11 Nodes

Answer 22

Station 11: interlobar nodes
* between the origin of the lobar bronchi

Question 23

Thoracic lymph node stations

Station 12 Nodes

Answer 23

Station 12: lobar nodes
* adjacent to lobar bronchi

Question 24

Thoracic lymph node stations