Nodal Status (N) Examples
Examples Regional Lymph Node
Status (N)
N1: Ipsilateral peribronchial or hilar nodal
metastases; or intrapulmonary nodes involved by direct extension of the primary tumor. All
N1 nodes lie distal to the mediastinal pleural reflection and are within the
visceral pleura [167].
Example 1: The patient shown below had a right lower lobe
adenocarcinoma with ipsilateral hilar nodal metastases (N1 nodes- yellow arrow). N1 nodes
do not preclude surgical resection, but are associated with a worse prognosis.
N2: Ipsilateral mediastinal and subcarinal lymph
nodal metastases. Midline pre-vascular and retrotracheal nodes are considered ipsilateral
[5], while nodes to the contralateral side of midline are considered N3 (Verbal
communication Dr. Clifton F. Mountain, MD, Division of Cardiothoracic Surgery, The
University of California Medical Center at San Diego). Although subcarinal nodes may
extend into the contralateral mediastinum, they are generally considered to be N2.
Example 1: The patient shown below had a
right upper lobe adenocarcinoma. There are enlarged ipsilateral right paratracheal (yellow
arrows) and pretracheal (white arrow) lymph nodes which were positive for metastases at
medistinoscopy. These are N2 nodes.
Example 2: There is a large subcarinal lymph node (white
arrows) in this patient with adenocarcinoma. During bronchoscopy, this node was biopsied
and was positive for malignant cells. Subcarinal nodes are generally considered N2 nodes.
N3: Contralateral mediastinal or contralateral
hilar nodal metastases; also includes ipsilateral or contralateral scalene or
supraclavicular nodes. Other cervical nodes are classified M1 [5].
Example 1: This patient with a right lung non-small cell
lung cancer had ipsilateral large mediastinal nodes (N2), which were compressing the
superior vena cava (yellow arrows), and large contralateral mediastinal adenopathy (white
arrows) consistent with N3 disease.
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view, simply click directly on the image below.
Example 2: This patient had a very central non-small cell
lung cancer (white arrows) and a large N2 node (red arrow). A right supraclavicular node
(blue arrows) was also positive for non-small cell lung cancer (N3 node).
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view, simply click directly on the image below.
