To explore the risk classification of papillary thyroid microcarcinoma (PTMC), and to provide reference for selecting the appropriate surgical method.

The clinical data of 148 PTMC patients admitted to our department from December 2019 to December 2022 were retrospectively analyzed. The results of preoperative ultrasonography, surgical methods, and intraoperative and postoperative pathological reports were summarized to obtain the risk classification of PTMC to select the appropriate surgical method.

The rate of lymph node metastasis was 40.5% in the total 148 PTMC patients, 19.5% in the 77 patients with single PTMC, and 63.4% in the 71 patients with multiple PTMC; the difference between the latter two groups was statistically significant. The accuracy and sensitivity of preoperative ultrasonography for diagnosing neck lymph node metastasis were 75.0% and 84.9%, respectively, and the accuracy for diagnosing multiple PTMC was 80.3%. We used preoperative ultrasonography and intraoperative frozen pathology as the classification indicators. The rate of lymph node metastasis was 4.9% in 61 low-risk PTMC patients, and 65.5% in 87 high-risk PTMC patients; the difference was statistically significant.

High-quality preoperative ultrasonography and accurate intraoperative frozen pathology can provide reliable information for the selection of appropriate surgical procedure. According to this classification, it is appropriate to perform thyroid lobe + isthmus resection in the low-risk group and total thyroid resection + affected lymph node dissection in the high-risk group.