Early　differentiation　of　cervical　lymphoma　from　benign　lymphadenopathy　remains　challenging　on　conventional　imaging.　This　study　assesses　the　diagnostic　efficacy　of　perfluorobutane　contrast-enhanced　ultrasound　(CEUS)　in　differentiating　early-stage　cervical　lymphoma　from　benign　lymph　nodes　(LNs).　From　November　2023　to　January　2025　we　prospectively　enrolled　patients　suspected　of　having　cervical　lymphoma　based　on　ultrasound　(US)　findings　and　scheduled　for　LN　biopsy.　All　patients　underwent　CEUS　to　evaluate　LN　vascular　(5-60　s　post-injection)　and　postvascular　(10-30　min　post-injection)　phases　before　biopsy.　Histopathology　served　as　the　reference　standard.　Diagnostic　performance　metrics,　including　sensitivity,　specificity,　and　accuracy,　were　calculated.　Logistic　regression　analyzed　the　area　under　the　receiver　operating　characteristic　curve　(AUC)　for　US,　CEUS,　and　combined　features.　Forty-seven　LNs　(23　lymphomas,　24　benign)　were　analyzed.　The　sensitivity　of　the　postvascular　phase　starfield　sign　was　91.30%,　specificity　was　83.33%,　positive　predictive　value　was　84.00%,　negative　predictive　value　was　90.91%,　and　the　AUC　was　0.87　(95%　CI　0.76-0.98).　The　AUC　for　CEUS　was　0.89　(95%　CI　0.79-1.00),　and　the　AUC　for　the　combination　of　postvascular　phase　and　US　features　was　0.92　(95%　CI　0.82-1.00),　significantly　higher　than　that　for　US　features　alone　(AUC,　0.68;　95%　CI　0.53-0.84;　P　＜　0.05).　Perflubutane　CEUS　can　effectively　distinguish　between　cervical　lymphoma　and　benign　LNs.　The　postvascular　phase　starfield　sign　demonstrates　significant　diagnostic　efficacy　and　could　improve　clinical　management　strategies.