Decision tree illustrating seven diagnostic branches. Following initial diagnostic workup (CT, PET scan), the clinician is faced with seven possible sampling approaches in order to discern malignant mediastinal lymphadenopathy.
◻ = initial decision node; = change node; ◃ = end of evaluation for that branch.
EUS = endoscopic ultrasound; FNA = fine needle aspiration; MED = mediastinoscopy; TBNA = transbronchial needle aspiration; EBUS = endobronchial ultrasound; + Bx = biopsy yielding malignancy.