Tumor size, TIRADS, and lymph node status as predictors of central neck dissection in thyroid cancer.

[INTRODUCTION] the aim was to evaluate the predictive value of tumor size, TIRADS classification, lymph node involvement, and demographic factors in guiding central neck dissection (CND) in patients with thyroid cancer.

[METHODS] this retrospective cross-sectional study included 437 patients, selected through convenience sampling, who underwent total thyroidectomy for thyroid cancer at a tertiary hospital in Riyadh, Saudi Arabia, from 2010 to 2023. Data collected included age, sex, BMI, tumor size, TIRADS level, lymph node status, and fine-needle aspiration (FNA) results. Associations with the performance of CND were analyzed using Pearson correlation coefficients and descriptive statistics.

[RESULTS] lymph node involvement, defined as histopathologically confirmed central lymph node metastasis, was the strongest independent predictor of CND (r = 0.5285, p < 0.0001), followed by tumor size (r = 0.4200, p < 0.0001) and TIRADS score (r = 0.2128, p = 0.0467). Age showed a weak but statistically significant association with CND (r = 0.1426, p = 0.0031), while sex and BMI had no significant impact. The majority of nodules were classified as TIRADS 3 to 5 (87.17%), and patients undergoing CND tended to be older with larger tumors and higher TIRADS categories.

[CONCLUSION] lymph node involvement, tumor size, and TIRADS classification are meaningful predictors of surgical management in thyroid cancer. Integrating these factors into preoperative evaluation supports a personalized approach to CND, potentially reducing unnecessary procedures and improving patient outcomes. These findings support the development of standardized, risk-adapted surgical criteria for central neck dissection in thyroid cancer.