Skip metastases in medullary thyroid carcinoma: a single-center experience.
OBJECTIVE
Total thyroidectomy (TT) with level VI and VII central neck dissection is the initial treatment for medullary thyroid carcinoma (MTC) without identifiable neck metastasis. Level II to V lateral neck dissection is performed if neck metastasis is present or suspected. We conducted this study to identify the frequency and clinical determinants of skip neck metastasis in MTC.


METHODS
We reviewed the medical records of 32 patients who underwent TT and bilateral neck dissection for MTC. The clinical features were correlated with pN status in the central versus lateral compartments of the neck.


RESULTS
Neck lymph node metastasis (pN+) was found in 20 patients (62.5%) and skip metastases were found in 7 (35%) patients. The sensitivity of the pN status of the central compartment of the neck to predict the pN status of the lateral compartment of the neck was 53.8% and specificity was 63.2%. We found pN+ in 90% of the patients with lymph nodes >15 mm in diameter versus 50% in those with lymph nodes <15 mm in diameter.


CONCLUSIONS
There is skip metastasis in MTC. It is unsafe to use the lymph node status of the central compartment of the neck to define the pN status of the lateral neck. A lymph node greater than 15 mm in diameter is related to pN status.
Department of Head and Neck Surgery, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
Marcos R
MR
Tavares
Pedro
P
Michaluart
Fabio
F
Montenegro
Sergio
S
Arap
Maria
M
Sodre
Flavio
F
Takeda
Lenine
L
Brandao
Sergio
S
Toledo
Alberto
A
Ferraz
D018276:Carcinoma, Medullary / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D037981:Neck Dissection; D013964:Thyroid Neoplasms / Q000473:pathology* / Q000601:surgery; D013965:Thyroidectomy