The aim of this study was to compare the diagnostic value of virtual touch tissue quantification (VTTQ) and strain ratio (SR) in differentiating malignant from benign cervical lymph nodes (LNs). The local institutional review board approved the study, and all patients provided written informed consent. A total of 144 LNs in 144 patients were examined with ultrasound elastography (UE) to obtain the SR, and with VTTQ technique to obtain the shear wave velocity (SWV) before taking core biopsies for standard reference. A receiver-operating characteristic (ROC) curve was generated to obtain the area under the curve (AUC) and the optimal cut-off point, after which the sensitivity, specificity, and accuracy of the two techniques were compared. In 144 LNs, 52 LNs were benign and 92 LNs were malignant. With ROC curve analysis, the optimal cut-off point was 2.170 for SR and 2.507 for VTTQ. The sensitivity, specificity and accuracy of SR and VTTQ were 78.26 %, 82.69 %, 79.86 % and 89.13 %, 90.38 %, 89.58 %, respectively. Specificity and accuracy were significantly higher for VTTQ than for SR (P<0.05). VTTQ is more accurate than SR in differential diagnosis of benign and malignant cervical LNs.