Comprehensive analysis of clinicopathologic and sonographic features in thyroid cancer with skip lymph node metastasis: establish and assessment of a prediction nomogram

Abstract Lateral Lymph Node Metastasis (LLNM) is common in Papillary Thyroid Carcinoma (PTC) and is associated with a poor prognosis. LLNM without central lymph node metastasis as skip metastasis is not common. We aimed to investigate clinicopathologic and sonographic risk factors for skip metastasis in PTC patients, and to establish a nomogram for predicting the possibility of skip metastasis in order to determine the therapeutic strategy. We retrospectively reviewed the data of 1037 PTC patients who underwent surgery from 2016 to 2020 at a single institution. Univariate and multivariate analyses were used to identify the clinicopathologic and preoperative sonographic risk factors of skip metastasis. A nomogram including the risk factors for predicting skip metastasis was further developed and validated. The incidence of skip metastasis was 10.7%. The univariate and multivariate analyses suggested that gender (p = 0.001), tumor location (p = 0.000), extrathyroidal extension (p = 0.000), and calcification (p = 0.000) were independent risk factors. For papillary thyroid microcarcinoma, tumor location (p = 0.000) and calcification (p = 0.001) were independent risk factors. A nomogram according to the clinicopathologic and sonographic predictors was developed. The receiver operating characteristic curve indicated that AUC was 0.824 and had an excellent consistency. The calibration plot analysis showed a good performance and clinical utility of the model. Decision curve analysis revealed it was clinically useful. A nomogram for predicting the probability of skip metastasis was developed, which exhibited a favorable predictive value and consistency. For the female PTC patient, tumor located at the upper pole is more likely to have skip metastasis. Surgeons and sonographers should pay close attention to the patients who have the risk factors. Evidence level: This article's evidence level is 3. Level 3 evidence is derived from nonrandomized, controlled clinical trials. In this study, patients who receive an intervention are compared to a control group. Authors may detect a statistically significant and clinically relevant outcome.

Investigating the characteristics of skip N2 metastasis in NSCLC / 中华胸心血管外科杂志

Objective To analysis the clinicopathological features of skip N2 metastasis in NSCLC in our clinical center,therefore guide for clinical decision making for NSCLC patients.Methods A total of 120 NSCLC patients with N2 metastasis treated by surgery were enrolled from January 2017 to May 2018,of which 55 were males and 65 were females.The mean age of them were (58.36 ± 11.34) years old.36 patients had skip N2 metastasis,accounting for 30％ of patients with N2 metastasis.48 patients had a history of smoking or a definitive history of second-hand smoke exposure,compared with other 72 patients.Collected pre-and post-operation clinical data of those patients,and carried out relevant statistical analysis.Results Among the NSCLC with skip N2 metastasis,it occulted more frequently in right lower lobe and peripheral lung cancer.The main pathological type was adenocarcinoma with acinar subtype.The most cases of skip N2 metastasis were characterized by single N2 station metastasis.Age of patients showed a significant difference between the two groups(P =0.049).Gender,smoking history,T staging of lung cancer,pathological type and involvement of pulmonary membrane showed no statistic difference between the two groups(P ＞ 0.05).Conclusion Patient with skip N2 metastasis seemed to be elder,and the lesions of those patients were more likely to be lung adenocarcinoma in the right lower lobe and peripheral lung cancer,often involved single N2 station.The lung cancer in right upper lobe often skipped to level R2 + R4,which in right middle lobe often skipped to levels R2 + R4 and 7,in right and left lower lobes skipped to level 7,in the left upper lobe often skipped to level 5.

Analysis of the relationship between ultrasonographic features and cervical lymph node skip metastasis of papillary thyroid micro-carcinoma / 中华肿瘤杂志

Objective@#To investigate the correlation between cervical lymph node skip metastasis with ultrasonographic characteristics of papillary thyroid micro- carcinoma (PTMC).@*Methods@#We reviewed ultrasonographic features of 385 primary PTMC and cervical lymph node metastasis, confirmed by pathology in Tianjin Medical University Cancer Institute and Hospital, to evaluate the efficacy of ultrasonography in the diagnosis of cervical lymph node metastasis of PTMC patients. The relationship between ultrasonographic features of primary lesions and skip metastasis of cervical lymph nodes was analyzed by χ2 test and multiple factor Cox regression.@*Results@#Among the 385 cases of PTMC patients with cervical lymph node metastasis, 231 cases were central lymph node metastasis alone, 31 cases were lateral cervical lymph node metastasis alone, 123 cases were both central and lateral cervical lymph node metastasis. Among the 354 cases without skip metastasis of cervical lymph nodes, 48 cases were level Ⅱ, 92 cases were level Ⅲ, 83 cases were level Ⅳ, 9 cases were level Ⅴ, 354 cases were level Ⅵ. Among the 31 cases with skipping metastasis of cervical lymph nodes, 12 cases were level Ⅱ, 14 cases were level Ⅲ, 14 cases were level Ⅳ, 1 case was level Ⅴ. The sensitivity and specificity of preoperative ultrasonography in the diagnosis of central cervical lymph node metastasis were 46.3% and 66.7%, respectively, and those of lateral cervical lymph node were 91.0% and 87.8%, respectively. Univariate analysis showed that the abutment/perimeter, diameter and location of PTMC were significantly associated with skip metastasis (P<0.05), multivariate analysis showed that abutment/perimeter and location of PTMC were significantly associated with skip metastasis (P<0.05).@*Conclusions@#The sensitivity and specificity of preoperative ultrasound diagnosis for lateral cervical lymph node metastasis of PTMC is higher than that of central metastasis. PTMC with abutment/perimeter ≥1/4 and upper portion location are prone to skip metastasis.

Skip metastasis to portocaval and retropancreatic space in T2 cecal cancer without regional and principle lymph node involvement

Lymph node metastasis in early colon cancer is relatively low. Furthermore, skip metastasis beyond principle lymph node is very rare. This is a case of early cecal cancer with skip metastasis to portocaval and retropancreatic space, without regional lymph node metastasis. A 69-year-old female diagnosed as cecal adenocarcinoma. The imaging study revealed as early cecal cancer without enlargement of regional lymph node. However, there is enlargement of portocaval lymph node and high fluorodeoxyglucose (FDG) uptake in positron emission tomography scan image. Right hemicolectomy with extended lymph node dissection was done including retropancreatic, portocaval and hepatoduodenal ligament lymph node. Though whole abdominal cavity exploration was done, there was no evidence of other synchronous cancer. The final pathologic findings revealed the poorly differentiated adenocarcinoma with invasion of submucosal layer and focally superficial layer of muscularis propria. Two of total 27 lymph nodes were involved by metastastatic adenocarcinoma which were from portocaval and retropancreatic space. The detailed preoperative imaging study could find unexpected lymph node metastasis beyond range of routine lymph node dissection. Even though the preoperative clinical stage is relatively early, the detailed and sufficient evaluation for clinical and imaging findings is important not to ignore skip metastasis.

Predictive factors of skip metastasis to lateral with leaping central lymph node in papil-lary thyroid carcinoma / 中国肿瘤临床

Objective:To retrospectively analyze the regularity and risk factors of skip metastasis (central lymph node negative and lat-eral lymph node positive) in papillary thyroid carcinoma (PTC). Methods:A total of 521 PTC patients underwent total thyroidectomy and central plus lateral lymph node dissection at The First Affiliated Hospital of Chongqing Medical University from January 2013 to De-cember 2016. Clinicopathological characteristics of the patients were collected and analyzed. Results:Skip metastasis rate of PTC was 8.3％(43/521). Tumors in the upper lobe (OR=3.401, 95％CI:1.770-6.536;P=0.001) and in the lateral part (OR=3.424, 95％CI:1.182-9.920;P=0.023) of the thyroid, as well as age above 45 (OR=2.856, 95％CI:1.488-5.482;P=0.002), were independent risk factors for skip metastases for this disease. Clinically node-negative (cN0) PTC patients with tumors in the upper lobe had higher possibility of skip metastases than those with clinically involved lateral neck nodes(cN1b) (P=0.022). Conclusion:Skip metastasis of PTC is not un-common. Thus, preoperative clinical assessment and imaging examination for lateral lymph node is necessary, especially for PTC pa-tients who are above 45 years old and with tumors in the upper lobe and/or unilateral area of thyroid. The lateral lymph node dissec-tion should be performed when necessary.

Lymph node metastasis: A bearing on prognosis in squamous cell carcinoma.

Nodal status is a significant predictor for survival of patients with oral squamous cell carcinoma (SCC), sentinel lymph node (SLN) biopsy, step sectioning of SLNs, and immunohistochemistry have changed the detection of tumor deposits in lymph nodes (LNs). The extent of LN metastasis is a major determinant for the staging and the prognosis of most human malignancies and often guides therapeutic decisions. Metastasis to regional lymph node (RLN) is a complex process. It is often associated with several clinical and pathological characteristics. The involvement of RLN is often, a harbinger for increased risk of metastasis. New knowledge in this area can enable the clinicians and pathologists to study and treat tumors in a more directed fashion. A molecular approach to factors that predicts the likelihood of RLN metastasis could eliminate the reoccurrence of the tumor in the form of “micrometastasis” and “skip” metastasis. The aim of this review is to discuss different modes of spread of metastasis in SCC.

Can One Predict the Incidence of Metastasis in Oral Squamous Cell Carcinoma Patients Using Tumor Thickness.

Aim: The present study was undertaken with the purpose to assess the correlation between the presence of lymph node metastases and the size of tumor and the thickness of the tumor mass. Methods: The study included 80 consecutive cases of oral squamous cell carcinoma, who underwent radical neck dissection. The various level of lymph nodes in these cases were checked for metastases, which was then correlated with the size of tumor and the thickness of the tumor. Results: In this study it was revealed that there is a statistically non-significant (p = 0.3204) correlation between size of the tumor and regional cervical lymph node metastases, but a significant correlation (p = 0.0148) between thickness of the tumor and regional cervical lymph node metastases was observed. Conclusion: Thus we conclude that the tumor thickness was more in cases with skip metastasis than in cases without skip metastasis and tumors greater than 10mm in thickness have more chances of regional metastases.

Predictive factors for lateral lymph node metastasis in papillary thyroid microcarcinoma / 中华内分泌代谢杂志

Objective To find the clinical and histopathological predictive factors for lateral lymph node ( LN ) metastasis in thyroid papillary microcarcinoma( PTMC ).Methods From January 2007 to December 2010,141 patients with PTMC underwent central and lateral LN dissections were enrolled in the study.The data from the cases were analyzed retrospectively to determine the predictive factors for lateral LN metastasis.Results Among the aforementioned cases,37 cases ( 26.2％ ) were PTMC with the presence of multifocality,24 ( 16.9％ ) Hashimoto thyroiditis,84 ( 59.6％ ) central LN metastasis,56 ( 39.7％ ) lateral LN metastasis.Multifocality,central LN metastasis,underlying Hashimoto thyroiditis,and upper pole location were significantly related to lateral LN metastasis in univariate analysis( P＜0.05 ).These four factors were also found to be independent predictive factors for lateral LN metastasis in multivariate analysis( P＜0.05 ).9(6.4％ ) of there patients were found to show skip metastasis in which there was lateral LN metastasis but no central LN metastasis.The upper pole location was statistically significantly associated with skip metastasis.Conclusions Patients with multifocality,central LN metastasis,underlying Hashimoto thyroiditis,and upper pole location should be paid more attention to the status of lateral LN.Skip metastasis occurs in a minority of patients with PTMC.Even if there is no central LN metastasis,patients with upper pole lesion should be searched carefully for the lateral cervical LN metastasis.

FDG-PET/CT Complements Bone Scan with Respect to the Detection of Skip Metastasis of Osteosarcoma: A Case Report / 대한골관절종양학회지

Skip lesion is not uncommon feature in osteosarcoma and considered to be importantly associated with poor prognosis factor, and thus, should be excised with the main mass. The accurate pre-operative evaluation of the intramedullary extent of osteosarcoma is essential, because it determines the level of bone resection. Among the reliable detection methods, bone scan has a drawback of high rate of false negative results and regional MRI has a difficulty to cover the whole involved lesions without clinical suspicion. The authors report a case of osteosarcoma of the distal femur with a proximal skip lesion that was not detected by either regional MR imaging or by bone scan, but which was visualized by FDG-PET/CT.

The Pattern of Cervical Lymph Node Metastases in Papillary Thyroid Cancer / 대한내분비외과학회지

PURPOSE: Cervical lymph node metastases are quite common in papillary thyroid cancer and the spreading route of a metastasis is usually in a sequential fashion. However, skip metastasis is not uncommon in node-positive papillary thyroid cancer. The goal of this study was to evaluate the pattern of cervical lymph node metastases in papillary thyroid cancer. METHODS: A total of the 265 patients with papillary thyroid carcinoma that underwent a total thyroidectomy and cervical lymph node dissection between January 2006 and August 2007 were enrolled in the study. Medical records were reviewed for analyses of the pattern of cervical lymph node metastasis. RESULTS: Cervical lymph node metastases were noted in 39.2% of the total cases and in 27.9% of the 197 patients that had only central lymph node dissection and 48.5% of the 68 patients that had central and lateral lymph node dissections. Among the cases of central and lateral node dissection, skip metastasis, lateral lymph node metastasis without central lymph node metastasis, was observed in 4 (5.8%) of the cases and a false positive result of node dissection was confirmed in 19 (28.1%) cases. CONCLUSION: For complete surgery of papillary thyroid carcinoma, a thorough examination of the cervical lymph node is required. Acareful consideration of the possibility of skip metastasis and false positive results in cervical lymph node dissection, especially in the lateral compartment, is necessary.