Skip metastases in medullary thyroid carcinoma: a single-center experience

Abstract
Purpose  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.

Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00595-007-3664-8Authors
Marcos R. Tavares, Hospital das Clínicas, University of São Paulo Medical School Department of Head and Neck Surgery Av. Dr Enéas de Carvalho Aguiar, 255 ICHC 8andar sala 8174, Cerqueira César CEP 05403-000 São Paulo BrazilPedro Michaluart, Hospital das Clínicas, University of São Paulo Medical School Department of Head and Neck Surgery Av. Dr Enéas de Carvalho Aguiar, 255 ICHC 8andar sala 8174, Cerqueira César CEP 05403-000 São Paulo BrazilFabio Montenegro, Hospital das Clínicas, University of São Paulo Medical School Department of Head and Neck Surgery Av. Dr Enéas de Carvalho Aguiar, 255 ICHC 8andar sala 8174, Cerqueira César CEP 05403-000 São Paulo BrazilSergio Arap, Hospital das Clínicas, University of São Paulo Medical School Department of Head and Neck Surgery Av. Dr Enéas de Carvalho Aguiar, 255 ICHC 8andar sala 8174, Cerqueira César CEP 05403-000 São Paulo BrazilMaria Sodre, Hospital das Clínicas, University of São Paulo Medical School Department of Head and Neck Surgery Av. Dr Enéas de Carvalho Aguiar, 255 ICHC 8andar sala 8174, Cerqueira César CEP 05403-000 São Paulo BrazilFlavio Takeda, Hospital das Clínicas, University of São Paulo Medical School Department of Head and Neck Surgery Av. Dr Enéas de Carvalho Aguiar, 255 ICHC 8andar sala 8174, Cerqueira César CEP 05403-000 São Paulo BrazilLenine Brandao, Hospital das Clínicas, University of São Paulo Medical School Department of Head and Neck Surgery Av. Dr Enéas de Carvalho Aguiar, 255 ICHC 8andar sala 8174, Cerqueira César CEP 05403-000 São Paulo BrazilSergio Toledo, Hospital das Clínicas, University of São Paulo Medical School Department of Head and Neck Surgery Av. Dr Enéas de Carvalho Aguiar, 255 ICHC 8andar sala 8174, Cerqueira César CEP 05403-000 São Paulo BrazilAlberto Ferraz, Hospital das Clínicas, University of São Paulo Medical School Department of Head and Neck Surgery Av. Dr Enéas de Carvalho Aguiar, 255 ICHC 8andar sala 8174, Cerqueira César CEP 05403-000 São Paulo Brazil

Journal Surgery TodayOnline ISSN 1436-2813Print ISSN 0941-1291

Journal Volume Volume 38

Journal Issue Volume 38, Number 6 / June, 2008 (Source: Surgery Today)