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PTMCs are not always low risk, as detection of lymph nodes metastasis (LNM) may occur. The purpose of the study was to analyze the clinical pattern, frequency, and independent risk factors of patients with PTMC and LNM. From January 2022 to June 2023, PTCs managed at CTO Hospital, Rome; Policlinico Vanvitelli, Naples; and Garibaldi Nesima Hospital, Catania were included. PTC management followed the same diagnostic\u2013therapeutic procedures according to the ATA guidelines. Variables such as age, sex, maximum diameter, histologic evidence of LNM (HELNM\u2009+), Hashimoto\u2019s thyroiditis (HT), multifocality, capsule invasion, and histological subtype were considered. PTCs were divided according to HELNM and size. Two hundred ninety-eight PTCs were included. PTMCs were 136 (45.6%) and LNM occurred in 27.2% of them. In the HELNM\u2009+\u2009group, analysis of PTMC vs \u2018MacroPTC\u2019 (PTC\u2009&gt;\u200910\u00a0mm) did not show any statistical difference. Multivariate regression revealed that young age (OR 0.93; CI 95% 0.90\u20130.96; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01) and male sex (male OR 3.44; CI 95% 1.16\u201310.20; <jats:italic>p<\/jats:italic>\u2009=\u20090.03) were the only independent risk factors for HELNM\u2009+\u2009in PTMC. The risk of LNM in PTMC is not negligible; therefore, a careful evaluation by an expert thyroidologist is mandatory for patients with small thyroid nodule, especially in younger and male patients before excluding surgery. In the future, new tools are needed to detect early PTMC with LNM before surgery.<\/jats:p>","DOI":"10.1007\/s13304-024-01779-6","type":"journal-article","created":{"date-parts":[[2024,3,6]],"date-time":"2024-03-06T05:02:02Z","timestamp":1709701322000},"page":"1055-1061","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Papillary thyroid carcinoma:\u2009\u2264\u200910\u00a0mm does not always mean pN0. 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