In recent years, thyroid cancer has become the most prevalent endocrine cancer in the world, in which papillary thyroid cancer (PTC) is the most common type, accounting for about 90% of all thyroid cancers. Although PTC has a favorable prognosis, some PTC patients will develop early lymph node metastasis, especially the central lymph node metastasis (CLNM), with metastasis rate of 21.2% to 64.1%. For patients with confirmed CLNM, performing central lymph node dissection (CLND) has been becoming widely accepted by domestic and international scholars. However, as for CN0 tumor, there is still controversial about whether or not prophylactic CLND should be performed as well as the surgical scope. China’s guideline for differentiated thyroid cancer suggests that ipsilateral CLND should be performed for patients with cN0 PTC on the premise of the effective technical guarantee. However, the latest guideline of the American Thyroid Association points out that prophylactic CLND is ineffective in improving long-term survival, but may increase the incidence of complications. So, whether or not performing a prophylactic CLND for cN0 PTC patients failed to reach a agreement. Here, the authors address the issues concerning the related factors, metastasis patterns, imaging evaluation and technical innovation of CLNM.