title: Tumor location-dependent skip lateral cervical lymph node metastasis in papillary thyroid cancer.
abstract: BACKGROUND
  Lateral cervical lymph node metastasis without central lymph node (CLN) metastasis is not infrequent in papillary thyroid cancer (PTC). This study was designed to investigate the frequency and pattern of skip metastasis in PTC.
  
  
  METHODS
  We reviewed 131 patients who underwent total thyroidectomy with CLN dissection and selective lymph node dissection. Tumor location was classified in 3 areas (upper, middle, and lower third) based on preoperative ultrasonographic findings.
  
  
  RESULTS
  All skip metastases occurred in patients whose tumors had been on the upper part of the thyroid (p < .001). Among 9 patients with skip metastasis, level III lymph nodes (66.7%) were the lymph nodes that were most frequently involved in skip metastasis.
  
  
  CONCLUSIONS
  Primary tumors in the upper portion of the thyroid are closely linked to skip metastasis. Careful preoperative evaluation of lateral cervical lymph nodes is suggested when a tumor is in the upper portion.
authors.affiliation: Department of Otorhinolaryngology - Head and Neck Surgery, Pusan National University School of Medicine and Medical Research Institute, Busan, Republic of Korea; Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Yoon Se
authors.initials: YS
authors.lastname: Lee
authors.forename: Sung-Chan
authors.initials: SC
authors.lastname: Shin
authors.forename: Yun-Sung
authors.initials: YS
authors.lastname: Lim
authors.forename: Jin-Choon
authors.initials: JC
authors.lastname: Lee
authors.forename: Soo-Geun
authors.initials: SG
authors.lastname: Wang
authors.forename: Seok-Man
authors.initials: SM
authors.lastname: Son
authors.forename: In-Ju
authors.initials: IJ
authors.lastname: Kim
authors.forename: Byung-Joo
authors.initials: BJ
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000473:pathology* / Q000556:secondary / Q000601:surgery*; D002291:Carcinoma, Papillary; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000473:pathology* / Q000556:secondary / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods; D016896:Treatment Outcome
keywords: lymphatic metastasis; neck dissection; papillary thyroid carcinoma; skip; univariate analysis