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In 2020, its incidence rate was 4.9%, ranking 9th for malignant tumors of both sexes, while its mortality rate was much lower, with rates of 0.5 per 100,000 in women and 0.3 per 100,000 in men ( Modern medical images have demonstrated good performance in detecting cervical LNs in PTC patients, in which both ultrasound (US) and computer tomography (CT) have achieved high levels of sensitivity and specificity, surpassing 80% ( 2 Preoperative diagnosis 2.1 Conventional US and contrast-enhanced US US continues to be the predominant imaging modality for the assessment of metastatic cervical adenopathy in PTC patients and serves as the major tool for both preoperative evaluation and follow-up examination ( Figure 1 ) ( Figure 1 ) ( Figure 1 Even so, a subsequent investigation revealed the suboptimal performance of CEUS in terms of diagnostic sensitivity for LNM within the diameter ranges of 05 mm and 510 mm, with sensitivities reaching only 61.0% and 66.6%, respectively ( 2.2 Computed tomography Following US, CT is recommended by the ATA2015 guideline to serve as a secondary option for imaging the status of cervical LNs ( 2.3 Fine-needle aspiration Guidelines strongly recommend FNA for the diagnosis of siLNs, of which fine needle aspiration cytology (FNAC) and fine needle aspiration thyroglobulin (FNA-Tg) are two popular techniques ( Table 1 ) ( Table 1 Indications for FNA biopsy recommended by classic guidelines for LNs ( ATA2015, 2015 American Thyroid Association Management Guidelines