| Objective:Papillary thyroid carcinoma(PTC)is the most common pathological type of thyroid cancer,as its risk factors for the recurrence of neck lymph node metastasis is also our in-depth analysis.In most cases,PTC cells have shifted direction along the lymphatic vessels of the neck.But we found that in some cases lateral lymph node metastases(LLNM)have taken place without central lymph node metastasis(CLNM),called"skip metastasis."At present lateral lymph node just gets therapeutic dissection in China.Doctors may not be careful of skip metastasis for patients without lymph metastasis in preoperational check.To investigate the correlation between skip metastasis of neck lymph node and clinicopathological features in PTC and find out the rules,we can better provide guidance for clinical therapeutic strategy.Methods:Totally 272 PTC patients with lateral lymph node metastases who received surgical procedure at Department of Thyroid Surgery,the First Hospital of the Jilin University from January 2014 to June 2016 were analyzed retrospectively.Accepted standard:(a)cases of patients with complete data;(b)patients with definite preoperative diagnosis of PTC by ultrasound and fine-needle aspiration cytology(FNAC);(c)patients with definite preoperational diagnosis of LLNM by ultrasound,CT and FNAC;(d)all cases undertook bilateral thyroidectomy,bilateral central lymph node dissection with unilateral/bilateral lateral lymph node dissection by same surgeon;(e)patients with postoperative diagnosis is PTC with lymph node metastasis by paraffin pathology;(f)patients without cervical surgical history,family history or radiotherapy history.There were 105 male and167 female patients,aging from 12 to 66 years with a mean age of(36.42±11.00)years.There were 29 patients(10.66%)with skip metastasis.And then the correlation between skip metastasis of neck lymph node and clinicopathological features(ages,gender,tumor size,tumor location,capsular invasion,multifocality,chronic lymphocytic thyroiditis and the distribution of LLNM)was analyzed by univariate?~2 test and multivariate Logistics regression test.Results:The rate of skip metastasis in all patients was 10.66%(29/272).By summarizing the distribution of the lateral lymph nodes about the patients with skip metastasis,11 male and 18 female patients(1 ratio 1.64),aging from 16 to 63 years with a mean age of(45.03±9.65)years,11 cases of microcarcinoma(37.93%),all cases of capsular invasion(100%),21 cases of multifocality(72.41%),24 cases of tumor located in the upper of the thyroid gland(82.76%),5 cases with chronic lymphocytic thyroiditis(17.24%),16 cases metastasized in single level(55.17%),meanwhile 6 in two levels(20.69%)and 7 in three levels(24.14%).Strong correlation between age,tumor location and skip metastasis was found using univariate?~2 test(?~2 values were 14.056 and 21.362 respectively,both P values were 0.000).Age(?45 years)(OR=4.318,95%CI 1.767 to 10.552,P=0.001),microcarcinoma(OR=2.623,95%CI 1.013 to 6.795,P=0.047)and the tumor located in the upper of the thyroid gland(OR=11.982,95%CI 2.533 to 56.173,P=0.002)were risk factors to the skip metastasis through multivariable Logistic regression analysis.Conclusions:Age?45 years old,microcarcinoma(tumor diameter?1cm)or tumor located in the upper part of the thyroid gland was more likely present with skip metastasis.Skip metastases are often involved in the lateral multi-level.Therefore,confronted patients with one of these risk factors,the occurrence of skip metastasis should be aware when the lateral lymph node was large abnormally.Accordingly,it may be appropriate to extend the indications of fine needle aspiration for lateral lymph node to prevent missed diagnosis.After the diagnosis of lateral cervical lymph node metastasis,it is necessary to remove the lymph nodes from?to?level. |
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