. Step 22 of 41
Clinical Stem 3
A patient with right upper lobe adenocarcinoma progressing on biomarker-directed therapy

The Case Continues
The multidisciplinary team chose to proceed with bronchoscopy and EBUS-TBNA. White light bronchoscopy showed normal airways. EBUS exploration of the mediastinum showed lymph nodes at stations 4R and 11R superior. EBUS-TBNA from both nodes was attempted. The nodes were very difficult to penetrate. A different inter-cartilaginous space was chosen for puncturing the nodes by redirecting the needle; the 4R lymph node could not be penetrated. Two aspirates of the 11R superior lymph node were obtained. However, on rapid on-site evaluation (ROSE), only blood and a few scattered lymphocytes were visualized