Chest ImagingLymph node classification, chest
classification that is based on easily analysed anatomical landmarks on
CT scans of the
lymph nodes in the
mediastinum and hila. It permits the localization of nodal stations on cross-sectional
CT images.
A new regional lymph node classification was provided by the American Joint Committee for Cancer (AJCC) and the Union Internationale contre le Cancer (UICC) for lung cancer staging
Lymph node classification, Table 1. 1996 AJCC - UICC DEFINITIONS
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| 1 | Highest mediastinal nodes. Nodes lying above a horizontal line at the upper rim of the left brachiocephalic (left innominate) vein where it ascends to the left crossing in front of the trachea at its midline. |
| 2 | Upper paratracheal nodes. Nodes lying above a horizontal line drawn tangential to the upper margin of the aortic arch and below the inferior boundary of No 1 nodes. |
| 3 | Prevascular and retrotracheal nodes. May be designated 3A (anterior) and 3P (posterior); midline nodes are considered to be ipsilateral. |
| 4R | Lower paratracheal nodes. On the right these nodes lie to the right of the midline of the trachea between a horizontal line drawn tangential to the upper margin of the aortic arch and a line extending across the right main bronchus at the upper margin of the right upper lobe bronchus, and contained within the mediastinal pleural envelope |
| 4L | Lower paratracheal nodes. On the left these nodes lie to the left of the midline of the trachea between a horizontal line tangential to the upper margin of the aortic arch and a line extending across the left main bronchus at the level of the upper margin of the left upper lobe bronchus, medial to the ligamentum arteriosum and contained within the mediastinal pleural envelope. |
| 5 | Subaortic nodes. Subaortic nodes are lateral to the ligamentum arteriosum of the aorta or left pulmonary artery and proximal to the first branch of the left pulmonary artery and lie within the mediastinal pleural envelope. |
| 6 | Para-aortic nodes. Nodes lying anterior and lateral to the ascending aorta and the aortic arch or the innominate artery, beneath a line tangential to the upper margin of the aortic arch. |
| 7 | Subcranial nodes. Nodes lying caudal to the carina of the trachea not associated with the lower lobe bronchi or arteries within the lung. |
| 8 | Paraoesophageal nodes (below carina). Nodes lying adjacent to the wall of the oesophagus and to the right or left of the midline, excluding subcarinal nodes. |
| 9 | Pulmonary ligament nodes. Nodes lying within the pulmonary ligament, including those in the posterior wall and lower part of the inferior pulmonary vein. |
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| 10 | Hilar nodes. The proximal lobar nodes, distal to the mediastinal pleural reflection and the nodes adjacent to the intermediate bronchus on the right; radiographically, the hilar shadow may be created by enlargement of both hilar and interlobar nodes. |
| 11 | Interlobar nodes. Nodes lying between the lobar bronchi |
| 12 | Lobar nodes. Nodes adjacent to the distal lobar bronchi |
| 13 | Segmental nodes. Nodes adjacent to the segmental bronchi |
| 14 | Subsegmental nodes. Nodes around the subsegmental bronchi |
PG