EBUS-TBNA & EUS-B-FNA Lymph Node Station Guide

Schematic diagram — relative station positions, not to anatomical scale. Drawn in standard radiological orientation: patient's right side appears on the image's left, patient's left on the image's right. Click a station number to jump to its detail.

The standard EBUS sonographic classification system referenced here was developed by Fujiwara T, Yasufuku K, Nakajima T, et al. (Chest. 2010;138(3):641–647), Department of Thoracic Surgery, Chiba University — the same institution and research group Dr. Chhajed worked directly with on the original 2004 EBUS-TBNA papers.

Accessible via EBUS-TBNA

Station 1R / 1L — Highest Mediastinal

Caudal to the inferior margin of the cricoid cartilage, cranial to the sternal notch and clavicles. The midline of the trachea is the left/right border.

Station 2R / 2L — Upper Paratracheal

Along the trachea, above the level of the aortic arch / azygos vein.

Station 4R — Lower Paratracheal (Right)

Lateral and anterior to the trachea, from the intersection of the lower border of the innominate vein and trachea, to the lower border of the azygos vein.

Station 4L — Lower Paratracheal (Left)

Left side, adjacent to the trachea, near the aortic arch.

Station 7 — Subcarinal

Between the two mainstem bronchi, below the carina. The most frequently sampled station in routine practice.

Station 10R / 10L — Hilar

At the origin of the lobar bronchi, adjacent to the mainstem bronchus.

Station 11R / 11L — Interlobar

Between the origins of the lobar bronchi. Station 11R may be subdivided into 11s (superior) and 11i (inferior).

Station 12 — Lobar

Adjacent to the lobar bronchi, more peripheral than station 11.

Accessible via EUS-B-FNA

Station 5 — Subaortic (Aortopulmonary Window)

Lateral to station 4L, caudal to the inferior border of the aortic arch, bounded by the ligamentum arteriosum.

Station 8 — Paraesophageal

Adjacent to the esophageal wall, below the level of the carina.

Station 9 — Pulmonary Ligament

Within the inferior pulmonary ligament.

Using the same bronchoscope for both EBUS-TBNA and EUS-B-FNA in one procedure extends total reach across nearly all clinically relevant mediastinal and hilar stations.

Referral Guide

Areas near the windpipe and airway branches

These are reached directly through the airway (EBUS-TBNA), the same way the scope is already passed to look at your lungs.

Areas near the food pipe (esophagus)

These are reached using the same instrument, guided briefly into the esophagus (EUS-B-FNA) — no separate procedure or additional scope is needed.

Together

These two approaches, performed in the same sitting, allow most of the relevant areas in the chest to be safely examined without surgery.