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The aim of this study was to investigate the pathological factors that influence prognosis in PTMC with the purpose of refining risk stratification based on our cohort of 311 cases. We performed a retrospective analysis based on anonymous data from 311 PTMC samples (tumours\u2009\u2264\u20091.0\u00a0cm in size) collected between 2016 and 2024. We examined several variables, including gender, histological subtype, tumour size, ETE, lymph node metastasis, and thyroiditis. The evaluations followed the eighth edition of the American Joint Committee on Cancer (AJCC) staging system. We used Pearson\u2019s chi-square test for univariate analysis and binary logistic regression for multivariate analysis. A\n                    <jats:italic>p<\/jats:italic>\n                    -value less than 0.05 was considered statistically significant. In our cohort, 45 patients (14.5%) had lymph node metastases. Male sex (OR\u2009=\u20093.3132; 95% CI\u2009=\u20091.5554\u20137.0574;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.002), age\u2009&lt;\u200945\u00a0years (OR\u2009=\u20092.4974; 95% CI\u2009=\u20091.2228\u20135.1006;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.012), multicentricity (OR\u2009=\u20092.9351; 95% CI\u2009=\u20091.4314\u20136.0182;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.003) and vascular invasion (OR\u2009=\u20093.5184; 95% CI\u2009=\u20091.3044\u20139.4905;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.013) are found to be independent risk factors for lymph node metastases. The tall cell histological subtype (OR\u2009=\u20093.897; 95% CI\u2009=\u20091.6649\u20139.122;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.002) emerged as an independent predictor of ETE. Although PTMC is commonly considered an indolent neoplasm, some cases may present aggressive features that require careful prognostic evaluation. The identification of independent risk factors may improve clinical decision-making and therapeutic strategies for patients with PTMC.\n                  <\/jats:p>","DOI":"10.1007\/s00428-025-04312-1","type":"journal-article","created":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T07:19:35Z","timestamp":1763450375000},"page":"405-411","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Nodal metastases in papillary thyroid microcarcinoma: prevalence and risk factors in 311 patients"],"prefix":"10.1007","volume":"488","author":[{"given":"Maria Letizia","family":"Lai","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priscilla","family":"Baldussu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7576-3137","authenticated-orcid":false,"given":"Jacopo","family":"Caschili","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luigi","family":"Minerba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Luisa","family":"Altana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Pinna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pietro Giorgio","family":"Cal\u00f2","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clara","family":"Gerosa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Fanni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,11,18]]},"reference":[{"key":"4312_CR1","unstructured":"Lloyd RV, Osamura RY, Kl\u00f6ppel G, Rosai J, World Health Organization, International Agency for Research on Cancer (2017) WHO classification of tumours of endocrine organs. 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