Objective: To study the role of High Frequency Ultrasound and color Doppler in diagnostic evaluation of cervical lymphadenopathy.

Methods: The present study was carried out in the Department of Radiodiagnosis, ESIC Medical College & Hospital, Faridabad. The study included sixty–four patients of different age groups presented with cervical lymphadenopathy. The nodal parameters included: site, mean long axis (L), mean short axis (S), shape index (S/L), echotexture and homogenicity, margins, ancillary features like calcification, necrosis, posterior enhancement, matting and surrounding tissue changes, vascular pattern and mean arterial resistive index (RI). The final diagnosis was reached by FNAC and excisional biopsy. The nodes were classified as reactive, lymphomatous and metastasis.

 Results: The study results showed that malignant LNs, especially metastatic, are accompanied with rounded shape, homogenous echotexture, peripheral vascularity and significantly high Resistive Index (RI). Among these sonographic findings, nodal shape (S/L ratio) and RI were more accurate for differentiating benign from malignant LNs. Most of the LNs with ill–defined margins were metastatic. Calcification, necrosis, posterior enhancement, matting and hilar flow pattern were characteristically found in tubercular lymphadenitis.

Conclusion: The sonographic findings had relatively high accuracy in differentiating benign from malignant cervical LNs. Ultrasound can be used as first line imaging tool in the diagnostic evaluation of cervical lymphadenopathy, especially in developing countries like India due to its ease, reproducibility and cost effectiveness.