New Endobronchial Ultrasound Imaging for Differentiating Metastatic Site Within a Mediastinal Lymph Node Takahiro Nakajima, MD, PhD, Masato Shingyouji,

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New Endobronchial Ultrasound Imaging for Differentiating Metastatic Site Within a Mediastinal Lymph Node Takahiro Nakajima, MD, PhD, Masato Shingyouji, MD, PhD, Hiroki Nishimura, MD, Toshihiko Iizasa, MD, PhD, Sachiko Kaji, MD, PhD, Kazuhiro Yasufuku, MD, PhD, FCCP, Hideki Kimura, MD, PhD Journal of Thoracic Oncology Volume 4, Issue 10, Pages 1289-1290 (October 2009) DOI: 10.1097/JTO.0b013e3181b05713 Copyright © 2009 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 1 The new ultrasound processor clearly visualized a subcarinal lymph node (No. 7), 15.1 × 9.3 mm in size, with borderlines apparent at the center of the lymph node (A). The lymph node was divided into two areas, a relatively low-echoic left side and a high-echoic right side (B). Power Doppler mode showed blood flow only in the left side (C), and color Doppler mode showed influx blood flow into the left side of the lymph node (D). Journal of Thoracic Oncology 2009 4, 1289-1290DOI: (10.1097/JTO.0b013e3181b05713) Copyright © 2009 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 2 We separately sampled the two sides of the subcarinal lymph node under ultrasound guidance. First, we sampled the right side of the lymph node (A) and obtained normal lymph node tissue (B). Then, we sampled the left side of the lymph node (C, hematoxylin and eosin; original magnification, ×400), and its histologic core revealed lymph node metastasis from the primary small cell lung cancer (D, hematoxylin and eosin; original magnification, ×400). Journal of Thoracic Oncology 2009 4, 1289-1290DOI: (10.1097/JTO.0b013e3181b05713) Copyright © 2009 International Association for the Study of Lung Cancer Terms and Conditions