Abstract Background Occult lymph node metastases (LNMs) occur in up to 50% of cN0 cT1b–T2 papillary thyroid carcinomas (PTCs) eligible for thyroid lobectomy (TL). Nevertheless the 2025 ATA guidelines discourage routine prophylactic ipsilateral central neck dissection (I-CND). This study assessed the impact of routine I-CND on risk stratification in unifocal cN0 cT1b–T2 PTCs scheduled for TL. Methods Among 6848 thyroidectomies for malignancy performed at 4 referral centers (2014–2025), 236 unifocal cN0 cT1b–T2 PTCs were scheduled for TL plus I-CND. ATA 2025 risk stratification with and without pathological nodal status (pN-status) was compared. Results Mean tumour size was 12.6±4.7 mm. pT-stage were pT1a, pT1b, pT3 and pT4 in 78, 145, 10, 2 and 1 cases, respectively. pN1a-status was found in 123 (52.1%) patients; LNMs2 mm was reported in 74 (31.4%) cases. The mean number of LNMs was 3.3±2.6. Extranodal extension occurred in 12 cases (5.1%; mean metastasis size 4.5±1.6 mm). Multifocality, vascular invasion, aggressive variants and extracapsular invasion were detected in 41.5%, 60.6%, 19.1% and 8.9% cases, respectively. Without pN-status evaluation, 54 (22.9%), 25 (10.6%), and 157 (66.5%) patients would have been classified as low, low-intermediate and intermediate-high risk. Incorporating pN-status resulted in significant risk upgrading: 48 (20.3%) low, 21 (8.9%) low-intermediate, 155 (65.7%) intermediate-high, and 12 (5.1%) high-risk patients (p0.001). Conclusions Routine pN-status evaluation significantly upgrades ATA risk category of cN0 cT1b–T2 PTCs eligible for TL. I-CND should be considered in these patients, as it provides precise staging and may reduce ipsilateral recurrence without increasing complication rate.
Laurino et al. (2026) studied this question.