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Arch Surg. 2004 Jan;139(1):43-5.

Skip metastases in thyroid cancer leaping the central lymph node compartment.

Author information

1
Department of General, Visceral, and Vascular Surgery, Martin-Luther-University Halle-Wittenberg, Halle, Germany. gensurg@medizin.uni-halle.de

Abstract

HYPOTHESIS:

Discontinuous nodal metastasis, or skip metastasis, in thyroid cancer may display clinicopathologic features different from those seen in continuous nodal metastasis and thus may have a different prognosis.

DESIGN:

Retrospective analysis.

SETTING:

Tertiary referral center at a university hospital.

PATIENTS:

Two hundred fifteen consecutive patients who underwent systematic central lymph node dissection for papillary, follicular, or medullary thyroid cancer and who on histopathologic analysis exhibited nodal metastases in at least 1 lateral or mediastinal lymph node compartment.

MAIN OUTCOME MEASURES:

Various clinicopathologic variables that were stratified for tumor entity and type of nodal metastasis (discontinuous vs continuous).

RESULTS:

Skip metastases (negative central and positive lateral or mediastinal compartments) were found in 13 (19.7%) of 66 papillary, 0 of 8 follicular, and 30 (21.3%) of 141 medullary thyroid cancers. After adjustment for multiple testing, skip metastasis was only associated with significantly fewer positive lymph nodes: 3.7 vs 12.9 nodes (r = -0.43, P<.001) in papillary thyroid cancer and 6.0 vs 17.1 nodes (r = -0.40, P<.001) in medullary thyroid cancer. No other significant correlation was identified with any other clinicopathologic variable.

CONCLUSIONS:

Skip metastasis is an epiphenomenon of low-intensity nodal metastasis in thyroid cancer and entails a moderate risk of local recurrence. Consequently, clearing the central lymph node compartment should be considered when lateral or mediastinal lymph node compartments are involved.

PMID:
14718274
DOI:
10.1001/archsurg.139.1.43
[Indexed for MEDLINE]
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