Squamous cell carcinoma is the most commonly encountered malignant neoplasm of the upper aerodigestive tract. The most important factor that influences therapeutic outcome is the development of metastasis to the cervical lymph nodes. Traditionally, assessment and staging have been based on clinical evaluation. Studies of clinicopathologic correlation have demonstrated that both the sensitivity and the specificity of the clinical examination findings are unsatisfactorily low in that false-negative rates may be 15%-25% while false-positive rates may be similarly high. The clinician is caught in the position of having to overtreat many patients to avoid undertreating a few. The rapid advances in imaging technology introduced in the past decade have greatly affected our ability to identify cervical metastatic disease. With improved technology and increased experience, patients can be better characterized individually according to the status of the cervical lymph nodes so that therapeutic intervention can be appropriately designed.