Skip metastases in thyroid cancer leaping the central lymph node compartment

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.