Clinicopathologic Predictors and Nodal Burden Pattern of Skip Metastasis in Papillary Thyroid Carcinoma: A Multicenter Study

Abstract

Background: Skip metastasis (SM), defined as lateral lymph node metastasis without central involvement, is an important but unpredictable spread pattern in papillary thyroid carcinoma (PTC). This study aimed to determine its prevalence, identify clinicopathologic predictors, and develop a preoperative risk model. Methods: We retrospectively analyzed 130 PTC patients with histologically confirmed lateral metastasis who underwent total thyroidectomy, bilateral central neck dissection, and unilateral or bilateral lateral dissection at three tertiary centers between 2019 and 2025. Clinicopathologic and nodal variables were compared between the SM and non-skip metastasis (NSM) groups. Independent predictors were evaluated using multivariable logistic regression, and model performance was assessed with ROC AUC. Results: SM occurred in 12.3% of patients. SM was associated with older age, upper-pole tumor location, solitary intrathyroidal focus, and lower nodal burden. Independent predictors were age ≥ 39.5 years and upper-pole location, while same-lobe multifocality was inversely associated. The model showed good discrimination with an AUC of 0.841. Conclusion: Older patients with solitary upper-pole PTC warrant meticulous preoperative lateral-neck assessment. A simplified preoperative model incorporating age, tumor topography, and multifocality may support risk-based surgical planning.