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Andreas Machens, MD; Hans-Jürgen Holzhausen, MD; Henning Dralle, MD

Arch Surg. 2004;139:43-45.

Hypothesis  Discontinuous nodal metastasis, or skip metastasis, in thyroid cancer may display clinicopathologic features different from those seen in continuous nodal metastasis and thus may have a different prognosis.

Design  Retrospective analysis.

Setting  Tertiary referral center at a university hospital.

Patients  Two hundred fifteen consecutive patients who underwent systematic central lymph node dissection for papillary, follicular, or medullary thyroid cancer and who on histopathologic analysis exhibited nodal metastases in at least 1 lateral or mediastinal lymph node compartment.

Main Outcome Measures  Various clinicopathologic variables that were stratified for tumor entity and type of nodal metastasis (discontinuous vs continuous).

Results  Skip metastases (negative central and positive lateral or mediastinal compartments) were found in 13 (19.7%) of 66 papillary, 0 of 8 follicular, and 30 (21.3%) of 141 medullary thyroid cancers. After adjustment for multiple testing, skip metastasis was only associated with significantly fewer positive lymph nodes: 3.7 vs 12.9 nodes (r = -0.43, P<.001) in papillary thyroid cancer and 6.0 vs 17.1 nodes (r = -0.40, P<.001) in medullary thyroid cancer. No other significant correlation was identified with any other clinicopathologic variable.

Conclusions  Skip metastasis is an epiphenomenon of low-intensity nodal metastasis in thyroid cancer and entails a moderate risk of local recurrence. Consequently, clearing the central lymph node compartment should be considered when lateral or mediastinal lymph node compartments are involved.

From the Departments of General, Visceral, and Vascular Surgery (Drs Machens and Dralle) and Pathology (Dr Holzhausen), Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.

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