Which classification of regional lymph node stations are used in mediastinal lymphadenectomy?

Updated: Feb 16, 2021
  • Author: R James Koness, MD, FACS; Chief Editor: Erik D Schraga, MD  more...
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Answer

The classification of regional lymph node stations for lung cancer staging reported by Mountain and Dresler in 1997 describes the anatomic landmarks for 14 levels of intrapulmonary, hilar, and mediastinal lymph nodes stations. [7] TNM classification for lung cancer classifies lymph node stations into six zones, as follows:

  • Peripheral (levels 12-14) or hilar (levels 10-11) for N1 nodes
  • Upper (levels 1-4) or lower mediastinal (levels 8-9), aortopulmonary (levels 5-6), and subcarinal (level 7) for N2 nodes (see the image below)
Regional lymph node stations. Regional lymph node stations.

N3 lymph nodes are contralateral mediastinal, ipsilateral scalene, or supraclavicular. Among the primary tumors that had only a single involved N2 station, the most common site of lymph node metastases was level 4R for right-upper-lobe tumors, levels 5/6 for left-upper-lobe tumors, and level 7 for middle- and lower-lobe tumors. [8]


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