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