IASLC lymph nodes map

1. RADIOLOGICAL ANATOMY OF THORACIC LYMPH NODES
Dr. HASEEB MANZOOR
DEPARTMENT OF RADIOLOGY
SHARIF MEDICAL CITY

2. MEDIASTINAL LYMPH NODES MAP
Proposed by “International Association for the Study of Lung Cancer” (IASLC) in 2009
The IASLC lymph node map defines 7 zones of mediastinal lymph nodes which are
further subdivided into 14 stations and most stations are again subdivided into right and
left
Assessing the lymph nodes by zone rather than station may help resolve dilemmas that
arise when contiguous adenopathy involves multiple adjoining stations

6. Station 1 :
Low Cervical, Supraclavicular, and Sternal Notch Lymph Nodes.
The midline of the trachea serves as the boundary between stations 1R and 1L.
1R 1L
SUPERIOR BORDER lower margin of cricoid
cartilage
lower margin of cricoid cartilage
INFERIOR BORDER Clavicles
upper border of manubrium
Thoracic inlet
Clavicles
upper border of manubrium
Thoracic inlet

8. Axial CT image obtained above the level of the thoracic inlet shows stations 1R and 1L
(purple area)
E = esophagus, TG = thyroid gland, T = mid line of trachea

9. Method for distinguishing low cervical lymph nodes from superior mediastinal lymph
nodes
structures anterior to a line bisecting the visible sections of the first ribs lie within the
neck, and structures posterior to this line lie within the superior mediastinum

10. Method for distinguishing low cervical lymph nodes from superior mediastinal lymph
nodes
As the plane of the thoracic inlet bisects the axial plane, the visible sections of the right
and left first ribs serve as reliable landmarks for the thoracic inlet

11. Station 2 :
Upper Paratracheal Lymph Nodes.
The left lateral border of the trachea (not the midline) serves as the boundary between
stations 2R and 2L.
2R nodes extend to the left lateral border of the trachea.
2L nodes are located to the left of the left lateral border of the trachea.
2R 2L
SUPERIOR BORDER apex of the right lung and
pleural space
upper border of the manubrium
apex of the left lung and pleural
space
upper border of the manubrium
INFERIOR BORDER intersection of the caudal
margin of the left
brachiocephalic vein with the
trachea
superior border of the aortic arch

14. Coronal reconstructed CT image shows the borders of stations 2R (dark blue area) and 2L
(light blue area)
☆ = left innominate vein

15. Axial CT image, obtained below the level of the thoracic inlet and above the level of the
intersection of the caudal margin of the left innominate vein (LIv) and the trachea (T),
shows stations 2R (dark blue area) and 2L (light blue area)

16. Station 3 :
Prevascular and Prevertebral Lymph Nodes.
3A nodes are not adjacent to the trachea, they are anterior to the vessels.
The midline of the trachea (T) serves as the boundary between right- and left-sided
station 3A.
3P nodes are behind the esophagus, which is prevertebral.
3A: Prevascular Nodes 3P: Prevertebral Nodes
SUPERIOR BORDER apex of the chest
Thoracic inlet
apex of the chest
Thoracic inlet
INFERIOR BORDER carina Carina
anterior border posterior surface of sternum posterior wall of the trachea
posterior border anterior border of the superior
vena cava (SVC) on the right
and the left carotid artery on the
left

20. Sagittal reconstructed CT image
shows the borders of stations 3A
(green area) and 3P (orange area)
★ = anterior margin of the SVC,
◆ = carina

21. Axial CT image, obtained below the level of the thoracic inlet and above the level of the
carina, shows stations 3A (green area) and 3P (orange area)
A = aorta, Az = azygos vein and arch, E = esophagus, IV-SVC = innominate vein–SVC
junction.

22. Station 4 :
Lower Paratracheal Lymph Nodes
The left lateral border of the trachea (not the midline) serves as the boundary between
stations 4R and 4L
4R nodes extend from the right to the left lateral border of the trachea
ligamentum arteriosum separates station 4L from station 5
4R 4L
SUPERIOR BORDER intersection of the caudal margin
of the left brachiocephalic vein
with the trachea
upper margin of the aortic arch
INFERIOR BORDER lower border of the azygos vein
right tracheobronchial angle
upper rim of the left main
pulmonary artery
left tracheobronchial angle

28. Axial CT image, obtained below the level of the intersection of the caudal margin of the
left innominate vein and the trachea and above the level of the tracheobronchial angle,
shows stations 4R (orange area) and 4L (peach area)
A = aorta, Az = azygos arch, E = esophagus

29. Coronal reconstructed CT image
shows the borders of stations 4R
(orange area) and 4L (peach area)
★ = innominate vein,
arrow = azygos vein,
▲ = aortic arch,
◆ = left pulmonary artery

30. Station 5 :
Subaortic Lymph Nodes
located lateral to the aorta and the pulmonary trunk, within the mediastinal pleural
envelope
located in the AP window lateral to the ligamentum arteriosum
ligamentum arteriosum separates station 4L from station 5
SUPERIOR BORDER lower border of the aortic arch
INFERIOR BORDER upper rim of the left main pulmonary artery

35. Station 6 :
Paraaortic Lymph Nodes
Anterior and lateral to the ascending aorta and aortic arch
SUPERIOR BORDER a line tangential to the upper border of the aortic arch
INFERIOR BORDER lower border of the aortic arch

38. Coronal reconstructed CT image
shows the borders of stations 5
(purple area) and 6 (red area)
PA = pulmonary artery

40. Axial CT images obtained above the
level of the carina show stations 5
(purple area) and 6 (red area)
A = aorta,
Av-SVC = azygos vein–SVC junction,
Az = azygos vein,
E = esophagus,
T = trachea

41. Axial CT images obtained above the
level of the carina show stations 5
(purple area) and 6 (red area)
A = aorta,
Av-SVC = azygos vein–SVC junction,
Az = azygos vein,
E = esophagus,
T = trachea

42. Station 7:
Subcarinal Lymph Nodes
SUPERIOR BORDER Carina
INFERIOR BORDER upper border of the lower lobe bronchus on the left
lower border of the bronchus intermedius on the right

45. Coronal reconstructed CT image
shows the borders of station 7
(pink area)

46. Axial CT image obtained below the
level of the carina shows station 7
(pink area)
Az = azygos vein,
E = esophagus.

47. Station 8:
Paraesophageal Lymph Nodes.
lie adjacent to the wall of the esophagus and to the right or left of the midline.
midline of the esophagus serves as the boundary between a right- and left-sided station
8 lymph node.
SUPERIOR BORDER upper border of the lower lobe bronchus on the left
lower border of the bronchus intermedius on the right
INFERIOR BORDER Diaphragm

49. Coronal reconstructed CT
image shows the borders of
station 8 (yellow area)

50. Station 9:
Pulmonary Ligament Lymph Nodes
lie within the pulmonary ligament
SUPERIOR BORDER inferior pulmonary vein
INFERIOR BORDER diaphragm

52. Station 10 :
Hilar Lymph Nodes
immediately adjacent to the main-stem bronchus and hilar vessels, including the
proximal portions of the pulmonary veins and main pulmonary artery
10 R 10 L
SUPERIOR BORDER lower rim of the azygos vein upper rim of the pulmonary artery
INFERIOR BORDER interlobar region interlobar region

56. Coronal reconstructed CT image
shows the borders of stations 10R
and 10L, which refer to lymph
nodes located along the main-stem
bronchi
Az v = azygos arch
BI = bronchus intermedius
LLL = left lower lobe bronchus
LUL br = left upper lobe bronchus
RLL br = right lower lobe bronchus
RML br = right middle lobe
bronchus
RUL br = right upper lobe
bronchus

57. Station 11:
Interlobar Lymph Nodes
Lie between the origin of the lobar bronchi
Station 11Rs
refers to lymph nodes located between the right upper lobe bronchus (RUL br) and the
bronchus intermedius (BI),
station 11Ri
refers to lymph nodes located between the right middle (RML br) and right lower (RLL br)
lobe bronchi
Station 11L
refers to lymph nodes located between the left upper lobe bronchus (LUL br) and the left
lower lobe bronchus (LLL br)

58. Coronal reconstructed CT image
shows the borders of stations
11R and 11L
Az v = azygos arch.

59. Station 12 :
Lobar Lymph Nodes
adjacent to the lobar bronchi
Station 13 :
Segmental Lymph Nodes
adjacent to the segmental bronchi
Station 14 :
Subsegmental Lymph Nodes
adjacent to the subsegmental bronchi

69. Other lymph nodes / Non-regional thoracic lymph nodes :
Not included in IASLC lymph nodes map.
Metastasis from lung malignancy may occur in non-regional thoracic lymph nodes
(distant metastases/stage M1b)
1. Internal Mammary (Internal Thoracic or Parasternal) Nodes
lie at the anterior ends of the intercostal spaces, along the internal mammary (internal
thoracic) vessels
2. Posterior Intercostal Nodes
located near the heads and necks of the posterior ribs
3. Juxtavertebral (Pre-vertebral or Paravertebral) Nodes
lie along the anterior and lateral aspects of the vertebral bodies, most common from T8
to T12

70. Axial CT image obtained at the level of
the left atrial chamber
internal mammary (orange areas)
and intercostal (yellow areas)

71. 4. Diaphragmatic Nodes
located on or just above the thoracic surface of the diaphragm
Further subdivided into three groups
A. Anterior (Pre-pericardial or Cardiophrenic) Group
located anterior to the pericardium, posterior to the xiphoid process, and in the right and
left cardiophrenic fat
B. Middle (Juxtaphrenic or Lateral) Group
C. Posterior (Retrocrural) Group
lie behind diaphragmatic crura and anterior to the spine

72. Axial CT image obtained at the level of the thorax-abdomen interface shows anterior
diaphragmatic lymph nodes (red area)

73. Axial CT image obtained at the level of the thorax-abdomen interface shows middle
diaphragmatic lymph nodes (green area)

74. References:
http://pubs.rsna.org/doi/full/10.1148/rg.346130097
http://www.radiologyassistant.nl/en/p4646f1278c26f/mediastinum-lymph-node-
map.html