Abstract
Skip metastasis is a specific type of papillary thyroid cancer lymph node metastasis (LNM). The present study aimed to clarify the typical clinical characteristics of skip metastasis and optimize the prediction model, so as to provide a more individual treatment mode for skip metastasis. We retrospectively analyzed 1075 PTC patients with different lymph node metastasis statuses from two clinical centers. Comparisons have been made between patients with skip metastasis and other types of LNM. Univariate and multivariate analyses were performed to detect the risk factors for skip metastasis with negative LNM, and a nomogram for predicting skip metastasis was established. The rate of skip metastasis was 3.4% (37/1075). Compared with other types of LNM, significant differences showed in tumor size, upper portion location, thyroid capsular invasion, and ipsilateral nodular goiter with the central lymph node metastasis (CLNM) group, and in age and gender with the lateral lymph node metastasis (LLNM) group. Four variables were found to be significantly associated with skip metastasis and were used to construct the model: thyroid capsular invasion, multifocality, tumor size > 1 cm, and upper portion. The nomogram had good discrimination with a concordance index of 0.886 (95% confidence interval [CI], 0.823 to 0.948). In conclusion, the significant differences between skip metastasis and other types of LNM indicated that the lymph node drainage pathway of skip metastasis is different from either CLNM or LLNM. Furthermore, we established a nomogram for predicting risk of skip metastasis, which was able to effectively predict the potential risk of skip metastasis in patients without preoperative LNM clue.
Highlights
Papillary thyroid cancer (PTC), accounting for 90% of thyroid cancer pathologies, is the most common type of cancer of the head and neck region, and its incidence is increasing worldwide [1,2,3]
According to the American Joint Committee on Cancer (AJCC, 8th edition) staging system, lymph node metastasis (LNM) is divided into N1a and N1b [14]
Preoperative ultrasound examination (US) and US-guide fine-needle aspiration (FNA) were performed strictly according to Thyroid Imaging Reporting and Data System (TI-RADS), Preoperative US provided standardized description of the number of tumors, tumor location, tumor size, tumor edge distance from capsule(
Summary
Papillary thyroid cancer (PTC), accounting for 90% of thyroid cancer pathologies, is the most common type of cancer of the head and neck region, and its incidence is increasing worldwide [1,2,3]. PTC is shown to involve cervical lymph node metastasis in 20–50% of patients with macrometastasis and in up to 90% of patients with micrometastasis detected by sensitive detection methods [9,10,11]. Spreading from the thyroid gland, the central and lateral lymph node compartments on the ipsilateral side of the thyroid tumor represent the first echelons of lymphatic drainage followed by the mediastinal and contralateral lateral lymph node compartments [12, 13]. According to the American Joint Committee on Cancer (AJCC, 8th edition) staging system, LNM is divided into N1a (central lymph node metastasis, CLNM) and N1b (lateral lymph node metastasis, LLNM) [14]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
