[Related factors on skip metastasis of neck lymph node in papillary thyroid carcinoma]

Objective: To investigate the correlation between skip metastasis of neck lymph node and clinicopathological features in papillary thyroid carcinoma. Methods: Totally 272 papillary thyroid carcinoma 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. There were 105 male and 167 female patients, aging from 16 to 73 years with a mean age of (42±8) years. There were 29 patients (10.7%) with skip metastasis. And then the correlation between skip metastasis of neck lymph node and clinicopathological features was analyzed by χ(2) test and multivariate Logistic regression test. Results: The rate of skip metastasis in all patients was 10.7% (29/272). By summarizing the distribution of the lateral lymph nodes about the patients with skip metastasis, 16 cases metastasized in single level (55.2%), meanwhile 6 in two levels (20.7%) and 7 in three levels (24.1%). Strong correlation between age, tumor location and skip metastasis was found using χ(2) test (χ(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 (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 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 awared 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 in order to prevent missed diagnosis.