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. 2017 Oct 25;17(1):702.
doi: 10.1186/s12885-017-3698-2.

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

Xilin Nie  1 , Zhou Tan  1 , Minghua Ge  2
Affiliations

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

Xilin Nie et al. BMC Cancer. .

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: Central lymph node metastasis; Lateral lymph node metastasis; Papillary thyroid carcinoma; Risk factors; Skip metastasis.

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Conflict of interest statement

Ethics approval and consent to participate

Institutional review board approval was waived by the responsible Ethics Committee of Zhejiang Cancer Hospital, Hangzhou, PRC, given the retrospective study design and analysis of clinical data. Patient records and information were anonymized and de-identified prior to analysis in all working stages. For this type of research, a formal consent is not required.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

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Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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