Background/Objectives: Transcutaneous ultrasound (US) is the first-line imaging modality for detecting and characterizing lymph nodes (LNs), enabling further lesion discrimination regarding potential malignancy. Accurate interpretation requires both knowledge of normal reference values and a multiparametric diagnostic approach. Methods: This narrative review was based on a comprehensive literature review. Results: The article summarizes current evidence on normal LN morphology and measurements in B-mode US, color Doppler imaging (CDI), elastography, and contrast-enhanced ultrasound (CEUS). Typical sonomorphologic features of benign and malignant LNs, including size, shape, echogenicity, vascular patterns, stiffness, and perfusion characteristics, are presented alongside corresponding reference values from published studies. The diagnostic limitations and overlaps between normal, inflammatory, and malignant LNs are highlighted, emphasizing potential pitfalls in interpretation. Multiparametric ultrasound combining B-mode, CDI, elastography, and CEUS enhances diagnostic confidence, reduces the need for invasive procedures, and supports standardized LN assessment in clinical and oncologic practice. Conclusions: This article is part of a series on normal reference values in US imaging. Knowledge of normal values and integration of multiparametric findings form the basis for accurate LN characterization and reduce the need for invasive diagnostics.
Möller et al. (Mon,) studied this question.