Endobronchial Ultrasound (EBUS) Mediastinal and Hilar LN Mapping

Station

Origin Upper Border Lower Border EBUS Scope

2R Nodes extending to the left lateral border of trachea

Apex of the right lung and pleural space, and in the midline, upper border of the sternal manubrium

Intersection of the caudal margin of innomate vein with trachea

Scope in the upper trachea at the level of 4-5th tracheal ring with the probe oriented towards the right lateral wall.

2L Apex of the left lung and pleural space, and in the midline, upper border of the sternal manubrium

Superior border of the aortic arch

Scope in the upper trachea at the level of 4-5th tracheal ring with the probe oriented towards the left lateral wall.

4R Includes right paratracheal nodes and pretracheal nodes, extending to the left lateral border of the trachea

Intersection of the caudal margin of innomate vein with trachea

Lower border of the AV Scope proximal to the main carina with the probe oriented to right antero-lateral wall of the trachea

10R Includes nodes immediately adjacent to the main stem bronchus and hilar vessels, including the proximal portions of pulmonary vein and pulmonary artery.

Lower rim of the AV on the right

Interlobar region bw RUL and BI

Scope in the proximal RUL with the probe oriented towards anterior and right lateral wall

7 Carina of the trachea The upper border of the lower lobe bronchus on the left, lower border of BI on

Scope in the RMB with the probe facing medially

the right4L Includes nodes to the left of

left lateral border of the trachea, medial to the ligamentum arteriosum

Upper margin of the aortic arch

Upper rim of the left main pulmonary artery

Scope in the proximal LMB at the level of main carina with transducer oriented to the left

10L Includes nodes immediately adjacent to the LMB and hilar vessels, including the proximal portions of pulmonary vein and main pulmonary artery.

Upper rim of the pulmonary artery on the left

Interlobar region between LUL and LLL

Scope in the proximal LUL with transducer oriented towards 11 o’clock position

11L Between the origins of left upper and lower bronchi

Scope in the proximal LLL at the level of carina with transducer oriented laterally

11Rs Between right upper lobe bronchus and BI

Scope in the proximal B1 with transducer oriented towards right lateral wall between 2 o’clock and 4 o’clock position

11Ri Between right middle and lower lobe bronchus on the left

Scope in the proximal RLL with transducer oriented towards the right lateral wall

15 steps performing EBUS-TBNA1. Advance needle through working channel. 9. Remove the stylet.

2. Secure the needle housing by sliding the flange. 10. Attach syringe.3. Release the sheath screw. 11. Apply suction4. Advance and lock the sheath when it touches the wall. 12. Pass the needle in and out of the node 15 times.5. Release the needle screw. 13. Release the suction by removing syringe.6. Advance the needle by using the “jab” technique. 14. Retract the needle into the sheath.7. Visualizing needle entering target mode. 15. Unlock and remove the needle and sheath and prepare smears.8. Move the stylet in and out a few times to dislodge bronchial wall debris.