Background: Routine prophylactic central compartment neck dissection in patients with differentiated thyroid carcinoma is not always accepted as a standard management of occult metastasis due to the risk of hypocalcaemia and recurrent laryngeal nerve injury.   Aim: To evaluate the accuracy of using sentinel lymph node biopsy as a guide in identifying occult cervical LN metastases early and thus to avoid the morbidity associated with routine unnecessary central lymph node dissection.   Patients and methods: A prospective study was conducted in the period between April 2015 and January 2017 in Ain Shams University Hospitals, General Surgery Department, Endocrine Surgery Unit, Cairo, Egypt. The study included fifty two patients who had at least one suspicious thyroid nodule and not accompanied by clinical or radiological cervical LN. The patients underwent sentinel lymph node biopsy via intra-tumoral injection of methylene blue dye 1%, followed by tracking the lymphatics till the sentinel LN then total thyroidectomy and central LN dissection.   Results: The study included 52 patients with suspicious thyroid nodule, 11 males and 41 females with mean age 41±6.7 (26-65). Co-morbid conditions included DM, HTN and ISHD. Size of nodules ranged from 0.8- 5.6 cm (1.9± 0.6) and most nodules were confined to one lobe (65.4%). After the final paraffin pathology 24 nodules were found to be benign and 28 proved malignant. SLNs were identified in 21 of 28 malignant cases (75%); number of sentinel LNs detected was 0-6 (2.8±1.9) and size ranged from 0.1- l.6 cm. 18 of identified SLN were positive for metastasis and 10 were negative while non SLN were positive in 15/28 and negative for 13/28. Thus, the sensitivity, specificity, negative predictive values, positive predictive values and accuracy of SLN biopsy were 85.7%, 100%, 70%, 100%, and 75%, respectively. Post-operative complications included temporary hypocalcaemia in 3 patients and extensive laryngeal edema in 1 patient needing prolonged intubation more than one day then recovered.   Conclusion: SLN biopsy for patients with differentiated thyroid carcinoma and negative LNs clinically and radiologically is an accurate and noninvasive means to identify subclinical lymph node metastasis and so can be used as a guide to determine the need for zone 6 LN dissection.