Objective To research on the diagnostic value of preoperative serum thyroglobulin (PS-Tg) and E-cadherin combined with ultrasound imaging characteristics for cervical lymph node metastasis in papillary thyroid carcinoma (PTC). Methods A total of 190 patients with papillary thyroid carcinoma (PTC) admitted to our hospital from May 2020 to May 2022 were selected. After surgery, pathological examinations were carried out on all of them, and they were divided into two groups: the metastatic group (with cervical lymph node metastasis, 102 cases) and the non - metastatic group (without cervical lymph node metastasis, 88 cases). The general data and ultrasonic imaging characteristics of the two groups were compared. Results The proportion of stage Ⅲ, ps - Tg, E - cadherin, and T - cadherin in the metastatic group were higher than those in the non - metastatic group (P<0.05). The proportions of tumor maximum diameter ranging from 0.7 cm to 1 cm, cystic change in lymph nodes, multiple lesions, thyroid capsule involvement exceeding 50%, peak systolic velocity (PSV)>13.95 cm/s, and RI>0.74 in the metastatic group were higher than those in the non - metastatic group (P<0.05). Logistic regression analysis was performed as follows: cTNM stage, ps-Tg, E-cadherin, T-cadherin, cystic change in lymph nodes, tumor maximum diameter, degree of thyroid capsule involvement, number of lesions, and PSV were independent risk factors for cervical lymph node metastasis in PTC patients (P<0.05). The results of ROC analysis showed that the AUC values for the individual diagnosis of cervical lymph node metastasis in PTC patients by ps-Tg, E-cadherin, T-cadherin, tumor maximum diameter, degree of thyroid capsule involvement, and PSV were 0.846, 0.572, 0.846, 0.853, 0.870, and 0.826 respectively. The AUC value of the combined diagnosis was 0.941, which was significantly higher than that of each individual indicator for diagnosis.Conclusion PS-Tg, E-cadherin, when combined with ultrasonic imaging features, possess relatively high diagnostic value for cervical lymph node metastasis in papillary thyroid carcinoma