Objective The study aimed to investigate the predictive efficacy of contrast?enhanced ultrasound combined with telomerase reverse transcriptase （TERT） promoter mutation in constructing nomogram model for the prediction of concomitant cervical lymph node metastasis （CLNM） in papillary thyroid microcarcinoma （pTMC）. Methods A total of 202 patients with pTMC who underwent partial or total thyroidectomy + lymph node dissection at our hospital from January 2021 to March 2024 were selected. Then， they were divided into the CLNM group （97 patients） and the non?CLNM group （105 patients） according to whether they had concomitant CLNM on postoperative pathological examination. General data and ultrasound （conventional ultrasound and contrast?enhanced ultrasound） characteristics were collected from all patients with pTMC， and Sanger sequencing was used to detect TERT promoter mutations. The influencing factors of pTMC complicated by CLNM were analyzed by single?factor and multifactorial unconditional logistic regression； the nomogram model of pTMC complicating CLNM with contrast?enhanced ultrasound combined with TERT promoter mutation was constructed by RStudio 4.4.1 software， and the consistency and net benefit of the nomogram model were evaluated by using calibration curves， decision curves， and C?indexes， and the Hosmer?Lemeshow test for goodness of fit of the nomogram model； The predictive efficiency of the nomogram model constructed by combining contrast?enhanced ultrasound and TERT promoter mutation for pTMC complicated by CLNM was evaluated by plotting receiver operating characteristic （ROC） curves using MedCalc22.023 software. Results After postoperative pathological examination， the incidence of CLNM in 202 patients with pTMC was 48.02% （97/202）. Univariate analysis showed that thyroglobulin antibodies， number of lesions， aspect ratio， microcalcifications， enhancement time， enhancement mode， enhancement intensity， capsular continuity， and TERT promoter mutations were associated with pTMC complicating CLNM （P < 0.05）. Multifactorial unconditional logistic regression showed that multifocal tumours （OR = 3.487， 95%CI： 1.641 ~ 7.406， P = 0.001）， microcalcifications （OR = 4.484， 95%CI： 2.113 ~ 9.516， P < 0.001）， equal or high enhancement （OR = 3.187， 95%CI： 1.460 ~ 6.957， P = 0.004）， disruption of peritoneal continuity （OR = 2.201， 95%CI： 1.051 ~ 4.608， P = 0.036）， and TERT promoter mutation positivity （OR = 4.460， 95%CI： 2.132 ~ 10.103， P < 0.001） were the independent risk factors for pTMC complicating CLNM. A contrast?enhanced ultrasound combined TERT promoter mutation nomogram model was constructed based on independent risk factors for pTMC complicating CLNM ［Logit （p）= -4.486 + 1.350 × number of foci + 1.399 × microcalcifications + 2.124 × intensity of enhancement + 1.524 × capsular continuity+2.175 × TERT promoter mutations］. The C?index of this nomogram model was 0.899 （95%CI： 0.893 ~ 0.905）， the calibration curve alignment was close to the ideal curve， the decision curve was higher than the two extreme curves， and the Hosmer?Lemeshow test showed a P > 0.05.The ROC curve analysis showed that the nomogram model constructed with contrast?enhanced ultrasound combined with TERT promoter mutations predicted CLNM in pTMC with an area under the curve of 0.899. This was significantly higher than the area under the curves for contrast?enhanced ultrasound alone （0.857） and TERT promoter mutations alone （0.697） （P < 0.05）. Conclusion The contrast?enhanced ultrasound combined with TERT promoter mutations to construct a nomogram model has high predictive efficiency for pTMC complicating CLNM.