Objectives: The clinical efficacy of the color and pulsed Doppler ultrasound with spectral waveform analysis for differentiation of malignant from benign cervical lymphadenopathy was prospectively evaluated in cervical lymphadenopathy. Materials and Methods: Color and pulsed Doppler ultrasound examination was prospectively performed in 32 cervical lymph nodes in 28 patients. These 10 nodes from 10 patients were malignant and 22 nodes from 18 patients were benign, proved by operation, biopsy, and follow-up examination. Another 12 lymph nodes from 12 normal volunteers were evaluated as control group. The peak systolic velocity (PSV), minimal diastolic velocity (MDV) , and resistive indexes (RI) of arterial flows within the 32 lymph nodes were assessed to differentiate the malignant from benign nodes with pulsed Doppler ultrasonography. The results were qualitified with one-way ANOVA and Bonferroni method of multiple comparison. Results: The mean values of PSV of malignant, benign, and control nodes were 38.2(10.1-134)cm/sec, 23.3(9-38.5) cm/sec and 11.8(6.7-18.1) cm/sec, respectively. The mean values of MDV of them were 0.9(-7.5-10.7)cm/sec, 9.7(2.9-18.6)cm/sec and 6.5(3.7-9.3)cm/sec, respectively. However, there was no statistical significance in differentiation of malignant from benign nodes with PSV and MDV. The mean values of RI of malignant, benign, and control nodes were 0.99(0.80-1.30), 0.59(0.46-0.77) and 0.45(0.38-0.50), respectively. RI value of 0.8 is suggestive value for discrimination of malignant from benign lymphadenopathy during examination of color Doppler ultrasound of cervical lymphadenopathy. Conclusion: Color and pulsed Doppler ultrasound examination with spectral waveform analysis may be quite helpful in the differentiation between benign and malignant alterations of cervical lymph nodes.