Risk factors analysis of cervical lymph node skip metastasis in the middle and lower pole papillary thyroid carcinoma
NI Ping
ZHANG Shuangyan
YAN Ziling
HUANG Chi
MA Bing'e
WANG Jianhua
Abstract：Objective This study aims to explore the clinical characteristics and risk factors of cervical lymph node skip metastasis in the middle and lower pole papillary thyroid carcinoma(PTC)patients.Methods The study retrospectively analyzed the data of PTC patients who underwent thyroid lobectomy and central plus lateral cervical lymph node dissection in Jiangsu Province Hospital with Integration of Chinese and Western Medicine from January 2022 to December 2023.The clinical characteristics and risk factors of skip metastasis in the middle and lower pole PTC patients were analyzed.Receiver operating characteristic(ROC)curve was used to determine the optimal cutoff value of age.Results Among the 131 PTC patients in this study,cervical lymph node skip metastasis occurred in 15 cases(11.45%)with the middle and lower pole PTC.The Ⅲ and Ⅳ cervical lymph node areas were the most common sites of metastasis in single or double areas.Age(OR=1.143,95%CI:1.055-1.238,P=0.001),tumor maximum diameter≤1 cm(OR=0.086,95%CI:0.014-0.515,P=0.007),and low TSH(OR=0.403,95%CI:0.168-0.967,P=0.042)were independent risk factors for skip metastasis in the middle and lower pole PTC.The number of central cervical lymph node dissection(OR=0.858,95%CI:0.741-0.994,P=0.041)and lateral cervical lymph node metastasis(OR=0.520,95%CI:0.286-0.891,P=0.018)were negatively correlated with skip metastasis in the middle and lower pole PTC.According to the ROC curve,the optimal age cutoff value for predicting skip metastasis was 35.5 years old(sensitivity=93.3%,specificity=41.4%,AUC=0.816,95%CI:0.717-0.915,P＜0.001).Conclusions Skip metastasis in the middle and lower pole PTC is not uncommon.When the patient's tumor is located in the middle and lower pole,the age is over 33.5 years old,and B-ultrasound indicates that the maximum diameter of the tumor is≤1 cm,a more detailed evaluation of the lymph node metastasis in neck side Ⅲ+Ⅳ should be performed before surgery,and B-ultrasound may need to be reviewed again before surgery if necessary.
Keywords：Papillary thyroid carcinomaLymph node skip metastasisLymph node metastasisLateral neck area
Publication Date：2024-08-20
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：6( 318-323 )