Real time high resolution ultrasonography (US) is thought to be the diagnostic tool of high sensitivity in detecting lymph nodes in patients diagnosed and follow-up for head and neck malignancies. Sensitivity and specificity of US are determined by quality of equipment, the kind of transducer and the experience of ultrasonographer. The diagnostic difficulties are met in small lymph nodes, less than 10 mm. Which sonographic picture is ambigious. It is very important in follow-up to avoid false-negative nodes and possibility of overtreatment of patient. The aim of the paper was to determine the sonomorphogic criteria which enable improving the specificity of neck ultrasonography especially in assessing the small, less then 10 mm lymph nodes. MATHERIAL AND METHOD: Ultrasonograph Aloka SSD 3500 and transducer 7.5 Mhz with 42 mm linear probe. The neck US was performed before the surgery. Maximal longitudinal diameter (L), maximal diameter (S), their ratio (S/L) which indicate the lymph node shape, echogenicity and internal echostructure were assessed. The features of the lymph node capsule, i.e. continuity, lost of echos were taken into consideration. The high echogenicity, the round shape of the node, lost of hilus central echo or it's marginal displacement correlate with malignant character of the node. Lost of echos in node capsule are not the indicator of the extracapsular spread. Using sonomorphologic criteria in assessment of small lymph nodes in the neck the authors stated the meaningful improving of US specificity.