Abstract
BACKGROUND AND PURPOSE: papillary thyroid carcinoma (PTC) as the most common thyroid tumor, tends to invade adjacent organs, especially lymphatic system. This study aimed to evaluate the discrimination performance of ultrasound elastography (USE) in assessing PTC nodule for determination of cervical lymph node metastasis (CLNM). METHODS: The protocol was pre-registered at ( https://osf.io/r5tc8 ). Using PubMed, Web of Science, Embase, and Cochrane Library, studies published up to March 10, 2025, were identified. Data extraction was conducted independently, and a random-effects bivariate model was applied to estimate pooled differentiation accuracy estimates. RESULTS: Twenty-one studies were included involving 7559 patients; 2790 (36%) were positive for CLNM, while 4769 (63%) were negative. The pooled E(mean) values for positive and negative CLNM were 51.2k Pa (95% CI: 42.6 to 59.7) and 44.8 kPa (95% CI: 35.2 to 54.4), respectively. It represents an absolute increase of 6.14 kPa (95% CI: 2.70 to 9.59) in the metastatic group compared to the benign group. Additionally, the pooled E(max) value for positive and negative CLNM were 87.9 kPa (95% CI: 49.5 to 126.4) and 68.7 kPa (95% CI: 44.2 to 93.1), respectively. This corresponds to an absolute increase of + 19.57 kPa (95% CI: 2.96 to 36.18) in the metastatic group, representing a more dramatic elevation compared to E(mean) values. The thyroid nodule E(max) and E(mean) were significantly higher for positive CLNM of + 27.5% (95% CI: 10.5-44.5%) and + 12.9% (95% CI: 5.1-20.7%) respectively. Combining USE with conventional ultrasound improved differentiation accuracy, achieving a sensitivity of 80% (95% CI: 62-90%), specificity of 79% (95% CI: 70-85%), and an AUC of 0.85 (95% CI: 0.81 to 0.88). CONCLUSION: USE parameters demonstrated potential as a discrimination tool for the preoperative assessment of CLNM, particularly when combined with conventional ultrasound, which enhances its performance. CLINICAL TRIAL NUMBER: N/A.