Background <p>Sonoelastography, also known as elastography, is a novel noninvasive imaging technique conducted using ultrasound equipment and used to indirectly evaluate tissue stiffness by measuring the speed of transverse wave propagation, or shear wave velocity, through the target tissue. Elastography is useful in diagnosing malignant lesions, which are stiffer than healthy tissue due to their high cell density.</p> Objective <p>The aim of this study was to assess the ability of elastography to differentiate between benign and malignant cervical lymph nodes.</p> Materials and methods <p>Over a period of 2.5 years, we prospectively assessed the cervical lymph nodes of pediatric patients who visited the ultrasound department of our institution. In the course of a single procedure, participants underwent B-mode and color Doppler ultrasonography and point shear wave elastography (pSWE) of the cervical lymph nodes. The participants were divided into three groups: control (I), reactive lymph nodes (II), and malignant lymph nodes (III). A histological examination was performed in all patients with suspected malignancy, and mean shear wave velocity was compared across the three study groups.</p> Results <p>Significant differences in elastography measurements were found between the lymph nodes in group I (control group) and group III (malignant lymph nodes) (<i>P</i>&lt;0.0001) and between group II (reactive nodes) and group III (malignant nodes) (<i>P</i>&lt;0.0001). Lymph nodes from patients in group III had higher elastography values than those in groups I and II.</p> Conclusion <p>pSWE is useful in measuring cervical lymph node stiffness, showing promising results in distinguishing between benign/reactive and malignant nodes.</p> Graphical Abstract <p></p>