Introduction: Cervical lymphadenopathy is a common clinical problem across all age groups. The main cause varies to differentiate reactive (infective) from malignant etiology. Cervical lymphadenopathy poses diagnostic challenge which is important for therapeutic and prognostic significance. Ultrasound elastography is a new imaging technique that can rapidly and noninvasively help to differentiate the benign and malignant lymphadenopathy to a great extent.. The main advantage of this method is its operator independence, reproducibility , high spatial resolution and quantitative assessment of the tissue elasticity without any tissue compression. It is a sensitive method for differentiation of cervical lymphadenopathy. Aim: The current study was conducted to evaluate the role of ARFI USG elastography in characterization and differentiation of benign from malignant cervical lymphadenopathy. Material and methods : The cross sectional study was conducted in the department of Radiodiagnosis, Hamdard institute of medical science and research, New Delhi over a period of one year from April 2021 to May 2022.presenting with cervical lymphadenopathy and USG elastography was done. The data gathered included grey scale, color Doppler and ARFI features of enlarged cervical lymph nodes. ARFI measurements of benign and malignant lymph nodes were compared using the student t test. For all tests, a p- value of less than 0.05 was considered to indicate a statistically significant difference. Result: The mean shear velocity of benign lymph nodes was significantly lower than that of malignant lymph nodes. Shear wave velocity (SWVs) value greater than 2.8m/sec was indicative of malignancy. Median shear wave velocity ranged between 1.7 to 8.4 in malignant lymph nodes and 1.0 to 2.8 in benign lymph nodes. Conclusion: ARFI technique helps in better differentiation of benign from malignant lymph nodes in conjunction with conventional sonography. The sensitivity and specificity of differentiation between benign and malignant lymph nodes using elastography was 79.1% and 100% respectively

Lymph nodes, benign, malignant, Shear wave velocity (SWV), tubercular lymphadenitis, lymphoma .