Objective To investigate the clinical value of ultrasound-guided fine-needle aspiration cell block immunohistochemical and gene testing for the elderly patients with supraclavicular lymph node metastasis of lung cancer. Methods From January 2014 to April 2016, we have collected 85 patients with supraclavicular lymph node metastasis of lung cancer. Using ultrasound-guided fine-needle aspiration, the specimens were obtained cytological smears, and also made into cell block for immunohistochemical and genetic testing. Combined with follow-up results, the diagnosis of cytological smears and cell block immunohistochemical were retrospectively analyzed and compared. Results In this study, 85 cases of patients and a total of 95 lymph nodes puncture with an average age of 62.68 years, , puncture success rate was 97.9%(93/95), including 21 lymph nodes negative. The lung cancer histological correct classification rate was 37.3%（25/67）under cytology, combined with cell block immunohistochemical, the histological correct classification rate was 59.1%（55/93）, between the two have significant differences. 37 cases of lung adenocarcinoma cell block samples in 22 cases of EGFR gene mutation detection, 16 cases of mutation positive, the mutation rate was 72.7%. Conclusions The diagnosis of supraclavicular lymph node metastasis of lung cancer is simple and practical under the ultrasound-guided fine-needle aspiration combined with cell block immunohistochemical. It also can improve the clinical diagnosis rate and provides a basis for individualized treatment of lung cancer.