Skip metastases in papillary thyroid cancer

Papillary thyroid carcinoma (PTC) is the most common malignant thyroid disease characterized by a high rate of cervical metastases (30-80%), especially due to paratracheal lymph node involvement. "Skip metastasis" are defined as a lateral lymph node metastasis without central lymph node involvement. The aim of this prospective study was to establish the lateral nodal metastasis pattern according to neck level, general occurrence and significance of skip metastasis in PTC. Forty-two previously untreated patients who presented between 2007 and 2011 with concomitant diagnosis of papillary thyroid cancer and metastatic disease of the lateral neck, underwent total thyroidectomy and central and lateral neck dissection. Skip metastases were encountered in 8 (19.5%) patients, four female and four male, with a mean age of 43.3 years. In all patients with lateral skip metastasis, level III nodes were most frequently involved (75%) followed by level IV (50%), while no metastatic disease was found in level IIb. Based on our research, skip metastasis are not uncommon (a lateral lymph node metastasis without central lymph node involvement) and present in approximately 1/5 of PTC patients with cervical lymph node metastasis.