Preoperative evaluation of cervical lymph nodes by ultrasound and palpation was compared retrospectively in 123 patients with tumours on the head and neck. The diagnostic accuracy was higher by ultrasound (96.5%) than by palpation (85.5%). Hence, the sensitivity for detecting cervical metastases was also higher for ultrasound than for palpation (96% versus 83%), because of the reduced false negative findings. Specificity, however, was higher for palpation (82%) than for ultrasound (74%). Ultrasound was superior in delineating the relationship of metastases to adjacent tissues (vessels). Major disadvantages of ultrasound were the higher percentage of false positive findings (26%) and absence if delineation of the relationship to bony structures.