Schematic representation of most common lymph node stations that can be punctured with EBUS- TBNA bronchoscope (according to Mountain-Dressler TNM classification). 

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... hypoechoic structures. Arteries are identified from their real-time ultrasonography pulsations synchronous with arterial pulse oximetry. Usually the veins are free of pulsations unless these are transmitted from adjacent arterial or cardiac structures. Doppler examination can be made before biopsies in order to increase confidence of identification and avoid blood vessel puncture. Lymph node stations 2L and 2R (left and right upper paratracheal), 4L and 4R (lower paratracheal), 7 (subcarinal), 10 (hilar) and 11 (interlobar) are those most commonly accessible to EBUS TBNA (Fig. 3). This technique can, in some cases, also access stations 1 (high mediastinal), 3 (pre-vascular and retrotracheal) and 12 (lobar) according to the well-known Mountain and Dressler classification of regional nodal stations for lung cancer staging. One major drawback of EBUS is its difficulty or inability to image and access stations 5, 6, 8 and 9 (subaortic, paraaortic, paraoesophageal and pulmonary ligament lymph nodes). Even with EBUS, the endoscopist has to keep in mind that tracheobronchial anatomical landmarks are essential to avoid inaccuracy in lymph node identification and staging. The EBUS-TBNA scope is particularly helpful in accessing station 2 in the left or right proximal trachea, as there are no particular endobronchial milestones at this level. It is also useful for station 4 at the distal tracheal level, since it can prevent puncture of the azygos arch on the right, and aorta or main pulmonary artery on the left side. Subcarinal lymph nodes are easily sampled on ...