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目的:初步构建颈部淋巴结恶性风险分级诊断评估系统。方法:前瞻性分析福建医科大学附属协和医院2018年7月至2019年12月301例颈部淋巴结病变患者的超声表现，包括短径、长径/短径比、边缘、边界、淋巴结间融合、淋巴门部、内部回声、无回声区、强回声点、高回声区、血流类型、血管分布等超声征象，以及患者恶性肿瘤史、颈部局部炎性表现、结核史，Logistic回归分析筛选出与良、恶性淋巴结相关的指标，并给予赋分。根据评分值对颈部淋巴结进行恶性风险分级评估。结果:与恶性淋巴结相关的指标：短径增大、长径/短径<2、强回声点、高回声区、边缘不规则、淋巴结间融合、异常血流类型、肿瘤史；与良性淋巴结相关的指标：颈部局部炎性表现、边界模糊。随着评分值的升高，颈部淋巴结的恶性风险升高。所构建的分级诊断系统的各级别淋巴结恶性风险：1级7.30%，2a级35.00%，2b级69.30%，2c级91.50%，3级99.05%。该系统的ROC曲线下面积为0.913。结论:本研究构建的颈部淋巴结恶性风险分级诊断系统有助于临床评估颈部淋巴结恶性风险。“,”Objective:To construct preliminarily the malignant risk classification system for the cervical lymph node.Methods:A total of 301 patients with cervical lymphadenopathy were collected in this prospective study from Union Hospital, Fujian Medical University from July 2018 to December 2019. The ultrasonographic features(including the short diameter, ratio of long to short diameters(L/S), margin, border, matting, echogenic hilum, echogenicity, gross necrosis, microcalcification, hyperechoic area, flow type, vascular distribution), history of malignancy, inflammation performance of the neck and history of tuberculosis were analyzed. A score was assigned for each significant index related to benign/malignant lymph nodes by a Logistic regression analysis. The classification of the malignant risk was determined on the basis of the scores.Results:The factors significantly associated with the malignant lymph nodes were enlargement of the short diameter, L/S<2, microcalcification, hyperechoic area, irregular margin, matting, abnormal flow pattern, malignancy history. While the factors related to the benign were the inflammation performance and the fuzzy boundary. The risk of malignancy increased as the score of lymph node increased. The malignant risk of lymph node according to the classification system was as follows: category 1, 7.30%; category 2a, 35.00%; category 2b, 69.30%; category 2c, 91.50%; and category 3, 99.05%. The area under the ROC curve of the system was 0.913.Conclusions:The system has great potential of clinical application to assess the risk of malignancy in cervical lymph nodes.