Thoracic lymph node stations

Dr Henry Knipe and Dr Tim Luijkx et al.

Thoracic lymph nodes are divided into 14 stations as defined by the International Association for the Study of Lung Cancer (IASLC) 1, principally in the context of oncologic staging. For the purpose of prognostication, the stations may be grouped into 7 zones.  The IASLC definitions leave some ambiguous regions which can lead to misclassification 3.

  • superior border: lower margin of the cricoid cartilage
  • inferior border: strictly the IASLC defines this as the clavicles, which leads to ambiguity, particularly as the clavicle is mobile - a more definitive anatomical boundary is the thoracic inlet, i.e. 1st rib 2 
  • left (1L) and right (1R) are divided by the mid-line of the trachea
  • station 1 nodes are outside the mediastinum and staged as an N3 disease; despite this, they can sometimes be treated with radical intent if they are encompassable in a radiotherapy field
  • superior border: apex of lung / pleural space, thoracic inlet 2
  • left (2L) and right (2R) are divided along the left lateral border of the trachea, not the midline
  • inferior border of 2R: at the intersection of caudal margin of the left brachiocephalic vein with the trachea, i.e. abuts 4R
  • inferior border of 2L: superior border of the aortic arch, i.e. abuts 4L
  • left (4L) and right (4R) are divided along the left lateral border of the trachea, not the mid-line
  • 4R:
    • superior border: intersection of caudal margin of the left brachiocephalic vein with the trachea, i.e. abuts 2R
    • inferior border: inferior border of the azygos vein
  • 4L:
    • superior border: superior border of the aortic arch, i.e. abuts 2L
    • inferior border: superior border of the left main pulmonary artery
  • pre-carinal nodes
    • lymph nodes anterior to the tracheal bifurcation are inferior to the above anatomic definitions and are thus technically unclassified by IASLC
    • these nodes are in the mediastinum (N2) and their surgical management mirrors that of 4R/4L lymph nodes, hence, pre-carinal nodes are best classified as part of the 4R/4L stations 2
  • lateral to ligamentum arteriosum
  • superior border: inferior border of the aortic arch
  • inferior border: superior border of the left main pulmonary artery
  • anterior and lateral to the ascending aorta and aortic arch
  • superior border: line tangential to the upper border of the aortic arch
  • inferior border: lower border of the aortic arch
  • superior border: station 7, i.e. upper border of lower lobe bronchus on left, and lower border of bronchus intermedius on right
  • inferior border: diaphragm
  • lying within the pulmonary ligament
  • superior border: inferior pulmonary vein
  • inferior border: diaphragm
  • immediately adjacent to mainstem bronchus and hilar vessels
  • superior border: lower border of the azygos vein on the right, the upper border of the pulmonary artery on the left
  • between the origin of the lobar bronchi
  • adjacent to lobar bronchi
  • adjacent to segmental bronchi
  • adjacent to subsegmental bronchi
  • subsegmental
Anatomy: Thoracic
Share article

Article information

rID: 35392
System: Oncology, Chest
Section: Staging, Anatomy
Tag: refs, cases
Synonyms or Alternate Spellings:
  • Thoracic lymph nodes
  • Thoracic lymph node
  • Thoracic lymph node classification
  • Thoracic lymph nodes classification
  • Thoracic lymph node levels
  • Mediastinal lymph node stations

Support Radiopaedia and see fewer ads

Cases and figures

  • Drag
    Figure 1
    Drag here to reorder.
  • Drag
    Figure 2: annotated CT
    Drag here to reorder.
  • Drag
    Figure 3: annotated CT with anatomy labels
    Drag here to reorder.
  • Updating… Please wait.
    Loadinganimation

    Alert accept

    Error Unable to process the form. Check for errors and try again.

    Alert accept Thank you for updating your details.