Utilization of the International Association for the Study of Lung Cancer and Wang's nodal map for the identification of mediastinum and hilar lymph nodes

Yang Xia; Yun Ma; Sixto Arias; Hans Lee; Ko-Pen Wang

doi:10.1111/1759-7714.12206

Utilization of the International Association for the Study of Lung Cancer and Wang's nodal map for the identification of mediastinum and hilar lymph nodes

Thorac Cancer. 2015 Jul;6(4):464-8. doi: 10.1111/1759-7714.12206. Epub 2015 Jan 8.

Authors

Yang Xia¹, Yun Ma², Sixto Arias³, Hans Lee³, Ko-Pen Wang²

Affiliations

¹ Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine Hangzhou, Zhejiang, China ; Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine Baltimore, Maryland, USA.
² Department of Respiratory and Critical Care Medicine, People's Hospital, Zhengzhou University Zhengzhou, Henan, China ; Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine Baltimore, Maryland, USA.
³ Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine Baltimore, Maryland, USA.

Abstract

Background: Transbronchial needle aspiration (TBNA), serving as a remarkably invaluable and minimally invasive technique, has been widely used for the diagnosis and staging of mediastinal adenopathy and masses. To date, the International Association for the Study of Lung Cancer (IASLC) and Wang's nodal map are two well-documented intrathoracic lymph node guidelines for the TBNA procedure.

Method: We characterized IASLC's and Wang's map, and interpreted the correlation of the two maps station by station.

Results: The pivotal role of IASLC map is to determine N descriptor in the tumor node metastasis (TNM) staging system of lung cancer, whilst Wang's map is employed to facilitate the localization of biopsy sites for bronchoscopists during TBNA performance. Furthermore, stations 1, 3 and 5 in Wang' map are equivalent to 4R station in IASLC' system, while stations 4 and 6 in Wang's account for IASLC station 4L as N2 stations. In addition, Wang's stations 2, 8 and 10 are correlated with station 7 in IASLC's. Wang's stations 7 and 9 are responsible for station 11R in IASLC's map.

Conclusion: Given their unique benefits and limitations, and the practical links between the two maps, it appears reasonable to highlight the significance of their complementary utilization upon TBNA performance and lung cancer staging.

Keywords: Bronchoscopy; TBNA; lymph node map.