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Prevalence, Risk Factors And Location Of Skip Metastasis In Papillary Thyroid Carcinoma: A Systematic Review And Meta-Analysis

Authors Qiu Y, Fei Y, Liu J, Liu C, He X, Zhu N, Zhao W, Zhu J

Received 7 January 2019

Accepted for publication 13 August 2019

Published 25 September 2019 Volume 2019:11 Pages 8721—8730


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Rituraj Purohit

Yuxuan Qiu,1,* Yuan Fei,1,* Jingyan Liu,2 Chang Liu,3 Xin He,4 Ning Zhu,5 Wan-jun Zhao,1 Jing-qiang Zhu1

1Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, People’s Republic of China; 2Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, People’s Republic of China; 3Public Policy and Administration, Department of Government, London School of Economics and Political Science, London, UK; 4West China School of Medicine, West China Hospital, Sichuan University, Chengdu, People’s Republic of China; 5Library and Information Science, School of Information Management, Nanjing University, Nanjing, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Jing-qiang Zhu
Department of Thyroid & Parathyroid surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan 610041, People’s Republic of China
Tel/Fax +86-28-85422467

Background: Skip metastasis is a special type in cervical lymph node metastasis (LNM) of patients diagnosed with papillary thyroid carcinoma (PTC) which induced poor prognosis. There are few studies about skip metastasis and conclusions remained uncertain. Therefore, this study aims to explore the frequency and to investigate risk factors of skip metastasis in PTC.
Methods: Through searching the keyword by PubMed and Embase databases which articles published up to 1st August 2018 about skip metastasis in papillary thyroid carcinoma, we extract data in order to assure whether those materials meet the criteria.
Results: The prevalence of skip metastasis is 12.02% in light of our meta-analysis of 18 studies with 2165 patients. The upper pole location (RR = 3.35, 95% CI =1.65–6.79, P = 0.0008) and tumors size ≤1 cm (RR = 2.65, 95% CI =1.50–4.70, P = 0.0008) are significantly associated with skip metastasis, whereas lymphovascular invasion (RR = 0.33, 95% CI =0.15–0.75, P = 0.0083) exists lower rate of skip metastasis. Multifocality, gender, age, bilaterality, thyroiditis and Extrathyroidal extension (ETE) are insignificantly associated with skip metastasis. Level II and level III are the most frequently affected areas.
Conclusion: The lateral compartment should be carefully examined especially for those PTC patients who present primary tumors in the upper lobe with a primary tumor size ≤10 mm which could be detected with skip metastasis.

Keywords: papillary thyroid carcinoma, skip metastasis, lateral neck dissection, meta-analysis

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