Ultrasonography-guided radiofrequency ablation (RFA) has been used to treat low risk small papillary thyroid carcinoma (PTC), and yielded promising results. However, little research has been performed on the application of RFA for the management of T1bN0M0 PTC. Therefore, This study was to compare the mid-term outcome of RFA with that of surgery for the treatment of clinical solitary T1bN0M0 PTC.Retrospective study.182 patients with solitary T1bN0M0 PTC between April 2014 and May 2019 who were treated with RFA or surgery (n=91/group).The primary end points were local tumor progression and complication rates. Local tumor progression were defined as: (1) new or persistent PTC confirmed by core needle biopsy; (2) cervical lymph node metastasis (LNM) confirmed by core needle biopsy or surgery; (3) ablation zone increased in the RFA group.In the RFA group, local tumor progression was seen in 4 patients (4.4%, 3 persistent PTC and 1 LNM). In the surgery group, 2 patients (2.2%) developed LNM; no new or persistent PTC were confirmed. There was no significant difference between the 2 groups in local tumor progression. Permanent hypoparathyroidism was observed in 4 patients (4.4%) in the surgery group, while no major or minor complications were observed in the RFA group.Ultrasonography-guided RFA is feasible and safe for treating solitary T1bN0M0 PTC, so it may be considered an alternative to surgery in select patients, especially those who are ineligible for or refusal of surgery.