Skip metastasis in papillary thyroid carcinoma is difficult to predict in clinical practice

• Published in: BMC cancer Vol. 17; no. 1; p. 702
• Main Authors: Nie, Xilin, Tan, Zhou, Ge, Minghua
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 25.10.2017; BioMed Central; BMC
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biopsy; Cancer metastasis; Carcinoma, Papillary - pathology; Carcinoma, Papillary - surgery; Care and treatment; Central lymph node metastasis; Child; Complications and side effects; Development and progression; Dissection; Female; Hospitals; Humans; Lateral lymph node metastasis; Lymph nodes; Lymph Nodes - pathology; Lymph Nodes - surgery; Lymphatic Metastasis; Lymphatic system; Male; Metastases; Metastasis; Middle Aged; Multivariate Analysis; Neck Dissection - methods; Papillary thyroid carcinoma; Patients; Regression analysis; Retrospective Studies; Risk Factors; Skip metastasis; Studies; Surgery; Thyroid; Thyroid cancer; Thyroid Cancer, Papillary; Thyroid Neoplasms - pathology; Thyroid Neoplasms - surgery; Ultrasonic imaging; Young Adult; China; United States > US; Central lymph node metastasis; Skip metastasis; Lateral lymph node metastasis; Papillary thyroid carcinoma; Risk factors
• ISSN: 1471-2407; 1471-2407
• DOI: 10.1186/s12885-017-3698-2

Cervical lymph node metastases are very common in papillary thyroid cancer (PTC), and typically spread in a predictable stepwise fashion in clinical practice. However, lateral lymph node metastasis (LLNM) without central lymph node metastasis (CLNM) as skip metastasis is not rare in PTC. The aim of this study was to investigate the incidence, risk factors and pattern of skip metastasis in PTC. A total of 271 patients with PTC and suspicious LLN diagnosed by pre-operation examinations who underwent total thyroidectomy and central lymph node dissection plus lateral lymph node dissection between January 2008 and December 2011 were enrolled in this study. Clinicopathological features were collected, and the pattern of cervical lymph node metastasis and skip metastasis were analyzed. The LLNM rate was 74.9% (203/271, diagnosed by postoperative pathology examination) and significantly associated with extrathyroid extension (ETE), primary tumor located at the upper pole, and CLNM (p < 0.05). The skip metastasis rate was 14.8% (30/203) and was more frequently found in microcarcinoma patients, especially when the primary tumor size was ≤0.5 cm (p = 0.001 OR = 12.9). However, skip metastasis was unrelated to the remaining factors examined. Small cancers with a pre-operation diagnosis of LLNM are more likely to have skip metastases, especially when the primary tumor size is less than 0.5 cm in diameter; however, this type of metastasis appears to develop in a random fashion. Thus, additional research is needed to identify potential predictive factors, such as a primary tumor located at the upper pole.