We investigated the pattern of regional recurrence pattern of intrathyroidal node negative - T1N0 or T2N0 - papillary carcinoma, focusing on skip versus continuous central and lateral lymph node metastasis. Most lymph node metastasis of papillary thyroid carcinoma appear in a step-wise sequential pattern, but discontinuous lymph node metastasis may occur in 11.1~37.5% in node positive papillary cancer. While skip metastasis has been studied on the synchronous central and lateral lymphatic clearance, it has not been studied in reoperative settings on lateral recurrence.

From January 2000 to December 2005, Two hundred and seventy-five T1/T2 N0 patients underwent reoperative lymphatic clearance after total thyroidectomy and clinical - not prophylactic - central neck dissection in Gwangju and Hwasoon Chonnam National University Hospitals. We enrolled 210 patients who showed central and lateral neck metastasis as the continuous recurrence group and 65 patients who showed lateral metastasis without central lymph node metastasis as the skip recurrence group.

Skip metastasis occurred in 17.6% (9/27 patients), and skip recurrence was in 23.6% (65/275 patients). In univariate analysis, in case of a single lesion, the skip recurrence was more prone to occur than multiple (P=0.026) and bilateral (P=0.048) papillary carcinoma. Multivariate analysis showed that tumor less than 1 cm (OR=2.24, P=0.009), single lesion (OR=3.23, P=0.019) for multiple lesion, and (OR=2.22, P=0.025) for bilateral lesion.

Skip metastases were found in 17.6% (9 out of 27) of patients, and skip recurrence in reoperative surgery was found in 23.6% (65 out of 275) of patients. Careful follow-up and low dose radioiodine therapy may be considered in T1N0 or T2N0 papillary carcinoma in selected patients.