To evaluate and determine the efficacy of ultrasound and Doppler for differentiating among various benign and malignant causes of cervical lymphadenopathy. Out of 88 cases, the final tissue diagnosis on the basis of histopathology was found to be tubercular in 35 (40%), reactive/inflammatory in 30 (34%), metastatic in 16 (18%), and lymphoma in seven (8%) cases with cervical lymphadenopathy. In our study, metastatic nodes were present in all neck lymph node levels but most commonly being the involvement of levels I, II, III, and V with most common primary site being oral cavity. Ninety percent of tubercular nodes were less than 3 cm in size, whereas majority of metastatic nodes were more than 3 cm in size with 40% of cases having size greater than 6 cm. Reactive nodes had L/S ratio of 2.1 ± 0.8, tubercular nodes had 1.7 ± 0.5, lymphomatous nodes had 1.6 ± 0.4, and metastatic nodes had 1.1 ± 0.4. Sixty-two percent of tubercular nodes and 44% of metastatic nodes had sharp border. Eighty-seven percent of metastatic nodes and 71% of lymphomatous nodes had absent hilus, while only 28% of tubercular nodes had absent hilus and 90% of reactive nodes had widened hilus. Fourteen percent of tubercular and 6% of metastatic nodes showed intranodal calcification. Seventy-one percent of tubercular and 68% of metastatic nodes had intranodal necrosis with cystic necrosis being commoner, and only 13% of reactive nodes showed intranodal cystic necrosis. Eighty-two percent of tubercular and 75% of metastatic nodes had matting. Twelve percent of metastatic nodes and 28% of tubercular nodes showed peripheral vascularity, whereas 87% of metastatic nodes and 71% of tubercular nodes showed mixed vascularity, and 60% of reactive nodes showed hilar vascularity. In our study of differentiating non-neoplastic from neoplastic lymphadenopathy on the basis of ultrasonography and Doppler with final histopathology, a sensitivity of 92.3%, specificity of 86.9%, PPV of 95.2%, and NPV 80.0% was found.