Objective To analyze the correlation between the sonographic features of papillary thyroid carcinoma (PTC), the detection of BRAF V600E gene and the metastasis of lymph nodes posterior to right recurrent laryngeal nerve (LN-prRLN).Methods The clinical data of 135 patients with PTC who underwent right lobular or bilobectomy from January 2016 to December 2019 were collected and analyzed. They were divided into LN-prRLN metastasis group and LN-prRLN non-metastatic group according to surgical pathology. Univariate and multivariate Logistic regression analysis were used to study the correlation between the sonographic features of primary tumors, BRAF V600E gene, and lymph nodes in the right cervical region and LN-prRLN metastasis.Results In this group of studies, the metastasis rate of LN-prRLN was 21.5% (29/135), and the rate of lymph node metastasis in the right cervical region was 25.9% (35/135). Preoperative ultrasound showed that the lymph nodes in group VI of the right neck were 55 example. There were statistically significant differences in age, maximum tumor diameter, envelope contact or involvement, and ultrasound showing lymph nodes in the right neck group VI, mutations in the BRAF V600E gene, and lymph node metastases in the right cervical side (all P <0.05). ); There were no significant differences in gender, whether it was accompanied by Hashimoto's thyroiditis, tumor location, internal echo, calcification type, and morphology (all P> 0.05). Multivariate Logistic regression analysis showed that ultrasound could show lymph node metastasis in group Ⅵ of right neck and lymph nodes in right lateral cervical region were independent related factors of LN-prRLN metastasis.Conclusions The presence of ultrasound in PTC patients can show group Ⅵ lymph node metastasis in the right neck or lymph nodes in the right cervical lateral region, which is a high risk factor for LN-prRLN metastasis. LN-prRLN dissection is recommended.