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Skip Metastasis in Papillary Thyroid Cancer: Is it Predictable?

Background: Cervical lymph node metastasis is a prognostic factor in papillary thyroid carcinoma (PTC). Metastasizing PTC to cervical lymph nodes is very common and occurs in 30-80% of patients. Aim: To investigate the risk factors of skip lateral lymph node metastasis in PTC patients. Methods: This retrospective study was conducted at a single institution and included PTC patients treated in the period between 2018 and 2021. All patients with PTC who underwent total thyroidectomy with central and lateral block neck dissection were reviewed for skip metastases which was confirmed by histopathologic examination. Results: During the study period, 267 patients with PTC underwent total thyroidectomy with central and/or lateral block neck dissection. Among them, only 64 patients matched the study inclusion criteria and their pathology was reviewed for skip metastases. Thirteen (20.3%) patients showed skip metastases. Their mean (±SD) age was 50.1 (±16.7) years and 8 (61.5%) were females. Only age ≥40 years and tumor size ≤ 0.5 cm differed significantly between patients with skip metastasis and those without. Conclusions: The results support the conduction of a prospective multi-centric study with a larger sample size to better understand the risk factors for developing skip metastasis in PTC. This would help in selecting patients with a risk for skip metastasis. bilaterality, multifocality, presence of psammoma bodies, tumor site and size, capsular invasion, extrathyroid extension, number of harvested central LNs and number of harvested/metastatic lateral LNs.