Skip metastases in papillary thyroid carcinoma: evidence from a multicenter European retrospective study

Introduction: Papillary thyroid carcinoma (PTC) frequently involves cervical lymph nodes. Lateral nodal involvement without central compartment disease (Skip Metastasis, SM) poses diagnostic and staging challenges. We aimed to characterize clinicopathological features of SM in a large multicenter European cohort comparing SM+ (lateral only) and SM- (central + lateral) disease. Materials and methods: We conducted a retrospective study across four high-volume European centers (01/2020-12/2022). Adults with histologically proven PTC, confirmed lateral cervical metastases, and both central (level VI) and lateral (levels II-IV) dissections were included. Additional subanalyses among pT1a and cases with >2 central nodes retrieved were employed to control for confounders. Results: Among 283 patients, 48 (17.0%) were SM +. SM+ patients were older (47 vs 39 years, p=0.006) and had smaller primaries (12 vs 16 mm, p=0.008), fewer microfoci (2 vs 3, p=0.013), fewer lateral nodes retrieved (22 vs 25, p=0.004), fewer positive nodes (2 vs 4, p