ABSTRACT Objective Subcentimeter papillary thyroid carcinoma (sPTC), also known as papillary thyroid microcarcinoma, is associated with a good prognosis and low mortality risk. However, some sPTCs exhibit biologically aggressive characteristics. The aim of this study was to identify factors affecting the prognosis and aggressiveness of sPTC by considering the demographic characteristics of patients with sPTC and the pathologic characteristics of the tumors. Subjects and methods The study included 255 patients aged ≥ 18 years who were operated on at Ondokuz Mayis University, Faculty of Medicine (Samsun, Turkey) between June 2008 and December 2021. All patients had histopathologic confirmation of sPTC (≤10 mm) and underwent regular follow-up for at least 36 months. Results The tumors had a mean size of 5 mm (0.1-10 mm) and were multifocal in 53.7% of patients. Capsular invasion was observed in 9% of patients. Vascular invasion, lymphatic invasion, and extrathyroidal invasion were present in 2%, 5.5%, and 0.8% of patients, respectively. Metastatic cervical lymph nodes were observed in 9.4% of patients. On multivariate logistic regression analysis, tumor size (odds ratio [OR] 1.380, 95% confidence interval [CI] 1.106-1.722, p = 0.004) and sex (OR 4.233, 95% CI 1.355-13.226, p = 0.013) were the main predictive factors influencing lymph node metastasis. Tumors > 5 mm, compared with tumors ≤ 5 mm, had higher rates of multifocality (p = 0.009), parenchymal invasion (p = 0.008), calcifications (p = 0.001), microscopic lymphatic invasion (p = 0.002), and presence of metastatic lymph nodes (p < 0.001). Conclusion The findings of this study highlight important factors to consider in making decisions about prophylactic central compartment neck dissection in patients with sPTCs, particularly those with clinically node-negative tumors. sPTC, , (sPTC) microcarcinoma risk However 25 1 University Samsun, Samsun (Samsun Turkey 200 2021 ≤10 10 (≤1 followup follow up 3 months 0.110 0110 0.1 0 (0.1-1 537 53 7 53.7 9 2 2% 55 5.5% 08 8 0.8 respectively 94 4 9.4 analysis odds OR [OR 1380 380 1.380 95 [CI 1.1061.722, 11061722 1.106 1.722, 106 722 1.106-1.722 0.004 0004 004 4233 233 4.233 1.35513.226, 135513226 1.355 13.226, 355 13 226 1.355-13.226 0.013 0013 013 metastasis 0.009, 0009 0.009 009 0.009) 0.008, 0008 0.008 008 0.008) 0.001, 0001 0.001 001 0.001) 0.002, 0002 0.002 002 0.002) 0.001. . nodenegative negative (sPTC 20 202 ≤1 (≤ 110 0.11 011 01 0. (0.1- 53. 5.5 9. 138 38 1.38 1061 1.1061.722 1106172 1106 1.10 1722 1.722 72 1.106-1.72 0.00 000 00 423 23 4.23 35513 1.35513.226 13551322 1355 1.35 13226 13.226 35 22 1.355-13.22 0.01 ( 11 (0.1 5. 1.3 1.1061.72 110617 1.1 172 1.72 1.106-1.7 0.0 42 4.2 3551 1.35513.22 1355132 135 1322 13.22 1.355-13.2 (0. 1. 1.1061.7 11061 17 1.7 1.106-1. 4. 1.35513.2 135513 132 13.2 1.355-13. (0 1.1061. 1.106-1 1.35513. 13551 13. 1.355-13 1.1061 1.106- 1.35513 1.355-1 1.3551 1.355-