The Essential cTBNA Bronchoscopist
The Essential Conventional TBNA Bronchoscopist© is the third of six volumes in The Essential Bronchoscopist™ Series. In addition to module-specific competency-oriented learning objectives and post-tests, it contains 30 multiple-choice question/answer sets pertaining to conventional transbronchial needle aspiration (cTBNA). Topics include mediastinal anatomy, proper equipment handling, patient preparation, procedural indications contraindications and complications, bronchoscopic techniques, nodal sampling strategies, lung cancer staging and classification, specimen collection, processing, and expected results for diagnosing malignant and benign mediastinal disorders.
The Essential Conventional TBNA Bronchoscopist© is the third of six volumes in The Essential Bronchoscopist™ Series. In addition to module-specific competency-oriented learning objectives and post-tests, it contains
30 multiple-choice question/answer sets pertaining to conventional transbronchial needle aspiration (cTBNA). Topics include mediastinal anatomy, proper equipment handling, patient preparation, procedural indications contraindications and complications, bronchoscopic techniques, nodal
sampling strategies, lung cancer staging and classification, specimen collection, processing, and expected results for diagnosing malignant and benign mediastinal disorders.
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Question I.5 Where are the right paratracheal lymph nodes (IASLC station 4R) in relation to the
trachea?
A. Posterior-lateral
B. Anterior-lateral
C. Lateral
D. Posterior
Answer: B
Nodal station 4R is anterolateral to the trachea, and can be accessed by needle aspiration at a
site that is two-four intercartilaginous spaces above the carina, aiming the needle anterolaterally
towards the 1 or 2 o’clock position (imagining the interior of the airway as a clock face and
using the carina as the central reference point). Aiming the needle more laterally risks
puncturing the azygos vein. The paratracheal lymph nodes are generally located slightly lateral
to the trachea. They are difficult to access because of the very lateral position required of the
needle and of the tip of the flexible bronchoscope, especially on the left (station 4L or
aortopulmonary window node).
IASLC level 4R
15
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