Which lymph nodes are accessible with bronchoscopy (bronchoscopic examination)?

From the Guidelines

Bronchoscopy allows access to several important lymph node stations in the mediastinum and hilar regions, including stations 2R, 2L, 4R, 4L, 7, 10R, 10L, 11R, and 11L, which can be sampled using endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) 1. The accessible lymph nodes include:

• Stations 2R and 2L (upper paratracheal)
• Stations 4R and 4L (lower paratracheal)
• Station 7 (subcarinal)
• Stations 10R and 10L (hilar)
• Stations 11R and 11L (interlobar) These nodes can be sampled using EBUS-TBNA, which has become the standard approach for mediastinal lymph node assessment, with a high diagnostic yield and minimal complications compared to more invasive surgical approaches 1. The technique involves inserting a bronchoscope with an ultrasound probe that visualizes the lymph nodes in real-time, allowing for precise needle placement and sampling. Accessing these lymph nodes is crucial for staging lung cancer, diagnosing granulomatous diseases like sarcoidosis, and evaluating for infections or lymphoma. The procedure is typically performed under moderate sedation or general anesthesia. Traditional transbronchial needle aspiration without ultrasound guidance can also access these stations but with lower accuracy 1. It is worth noting that EBUS-TBNA has a pooled diagnostic accuracy of 79.1% for diagnosing sarcoidosis, and it is recommended to use EBUS-TBNA for diagnosis in patients with suspected sarcoidosis with mediastinal and/or hilar adenopathy 1.

From the Research

Lymph Nodes Accessible with Bronchoscopy

The following lymph nodes are accessible with bronchoscopy:

• Paratracheal lymph nodes 2, 3, 4
• Subcarinal lymph nodes 2, 3, 5, 4
• Hilar lymph nodes 2, 3, 5, 4
• Mediastinal lymph nodes located adjacent to the oesophagus, which can be assessed by transoesophageal ultrasound-guided fine needle aspiration (EUS-FNA) 2, 4

Specific Lymph Node Stations

The studies also mention the following specific lymph node stations that can be accessed with bronchoscopy:

• Station 7 (subcarinal) 5
• Station 4R (right lower paratracheal) 5
• Station 10R (right hilar) 5

Diagnostic Techniques

The studies discuss the use of various diagnostic techniques, including:

• Transbronchial needle aspiration (TBNA) 2, 3, 5, 6
• Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) 2, 3, 4
• Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) 2, 4
• Transbronchial lymph node forceps biopsy (LN-TBFB) 6