[Risk factors of skip lateral cervical lymph node metastasis in papillary thyroid carcinoma]

Objective:To investigate the incidence and risk factors of skip lateral cervical lymph node metastasis in patients with papillary thyroid carcinoma（PTC）. Methods:The clinical and pathological data of 85 patients with PTC who underwent total thyroidectomy plus central and lateral neck dissection in the Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Hebei North University from January 2018 to January 2022 were analyzed retrospectively. SPSS 26.0 software was used to process the data, and univariate and multivariate analysis were performed to assess the relationships between skip lateral cervical lymph node metastasis and clinicopathological characteristics. Results:There were 31 cases（36.5%） of skipped lateral cervical lymph node metastasis. Univariate analysis showed that the largest tumor diameter ≤5 mm（P=0.006） and the tumor located in the upper pole of the thyroid（P=0.002） were associated with the occurrence of skip lateral cervical lymph node metastasis in patients with PTC. Most of the skip metastases involved a single area（18/31, 58.1%）, of which area Ⅲ was most likely to be involved（10/31, 32.3%）, followed by area Ⅱ（5/31, 16.1%）. The results of binary logistic analysis showed that tumor diameter less than 5 mm（OR 7.800, 95%CI 1.710-21.394, P=0.005） and tumor at the upper pole of the gland（OR 4.060, 95%CI 1.468-11.235, P=0.007） were independent risk factors of skip lateral cervical lymph node metastasis in PTC patients. Conclusion:PTC patients with tumor diameter ≤5 mm and tumor located in the upper pole of the gland are more prone to skip lateral cervical lymph node metastasis. When the diameter of the tumor is less than 5 mm and the tumor is located at the upper pole of the gland, careful evaluation should be made before operation, even in the absence of central lymph node metastasis, attention should be paid to the possibility of lateral cervical lymph node metastasis.