Department of Surgery, Eulji University Hospital, Eulji University College of Medicine, 1306 Dunsan-dong, Seo-gu, Daejeon, 302-799, South Korea.
World J Surg. 2012 Apr;36(4):743-7. doi: 10.1007/s00268-012-1476-5.
Papillary thyroid carcinomas (PTCs) are commonly associated with lymph node metastases (LNMs), which are thought to disseminate sequentially, first to the central compartment and later to the lateral compartment. However, a small number of patients have skip metastases to the lateral compartment without central LNMs. This study was performed to evaluate the clinicopathologic characteristics of skip metastases in PTC.
We reviewed the medical records of 147 patients who underwent total thyroidectomy with central neck dissection plus modified radical neck dissection (RND) for PTC. A single surgeon performed all operations. The patients were classified as either present or absent skip metastases. The clinicopathologic characteristics were statistically analyzed.
Skip metastases were found in 32 patients (21.8%) and occurred commonly with primary tumors of the upper pole, and with tumors ≤1 cm in diameter. Skip metastases were less common in patients with multifocal disease. Patients with skip metastases had fewer metastatic lateral nodes that were more frequently found at a single level: mostly at level III (96.9%) and level II (34.4%).
Although skip metastases occur in only a small number of patients, the lateral compartment should be carefully evaluated for skip metastases, even though primary tumors are either single focus, located in the upper pole, or ≤1 cm in diameter.
甲状腺乳头状癌（PTC）常伴有淋巴结转移（LNM），通常认为这些转移是依次发生的，首先转移到中央区，然后转移到侧区。然而，有少数患者存在中央区无淋巴结转移的侧区跳跃性转移。本研究旨在评估 PTC 中跳跃性转移的临床病理特征。
我们回顾了 147 例因 PTC 行甲状腺全切除术+中央区颈清扫术+改良根治性颈清扫术的患者的病历。所有手术均由同一位外科医生完成。将患者分为存在跳跃性转移和不存在跳跃性转移。对其临床病理特征进行统计学分析。
32 例（21.8%）患者存在跳跃性转移，且常见于上极原发肿瘤和直径≤1cm 的肿瘤。跳跃性转移在多发病灶患者中较少见。存在跳跃性转移的患者转移的侧区淋巴结较少，且常位于单一水平：主要位于 III 水平（96.9%）和 II 水平（34.4%）。
尽管跳跃性转移仅发生在少数患者中，但即使原发肿瘤为单灶、位于上极或直径≤1cm，也应仔细评估侧区是否存在跳跃性转移。
