Diagnostic Value of Contrast-Enhanced Ultrasound for Differentiating Benign and Malignant Thyroid nodules: A Systematic Review and Meta‑Analysis

This systematic review and meta-analysis aimed to evaluate the diagnostic accuracy of contrast-enhanced ultrasound (CEUS) for distinguishing between benign and malignant thyroid nodules. A search of the PubMed, Embase, Cochrane library, and Web of Science databases was conducted up to January 1, 2025. Studies that reported the diagnostic performance of CEUS for the identification of benign and malignant thyroid nodules and used postoperative pathology as the reference standard were selected. The pooled sensitivity, specificity, diagnostic odds ratio (DOR), positive likelihood ratio (PLR), and negative likelihood ratio (NLR) were calculated, and the area under the summary receiver operating characteristic (SROC) curve was used to examine the diagnostic accuracy of CEUS. In addition, subgroup and meta-regression analyses were conducted to evaluate the factors leading to heterogeneity. Overall, 29 cohort studies involving 3521 thyroid nodules from 3197 patients were identified. The pooled sensitivity, specificity, PLR, NLR, and DOR values of CEUS in differentiating benign and malignant thyroid nodules were 0.86 (95% CI, 0.83-0.89), 0.86 (95% CI, 0.82-0.89), 6.14 (95% CI 4.83-7.80), 0.16 (95% CI 0.12-0.20), and 38.90 (95% CI, 26.28-57.57), respectively. The area under the SROC curve was 0.93 (95% CI 0.90-0.95). This meta-analysis indicated that CEUS is useful for the differential diagnosis of patients with benign and malignant thyroid lesions. Owing to its high sensitivity, specificity, and diagnostic advantages, CEUS can be considered a useful supplement to conventional ultrasound.