Diagnostic performance of contrast-enhanced ultrasound for thyroid nodule characterization: a systematic review and meta-analysis

BackgroundDifferentiating benign from malignant thyroid nodules is essential for effective patient management.PurposeTo evaluate the diagnostic performance of contrast-enhanced ultrasound (CEUS) for thyroid nodule characterization based on currently available evidence.Material and MethodsWe conducted a systematic review and meta-analysis of studies evaluating the diagnostic accuracy of CEUS for thyroid nodules. PubMed, Scopus, and Web of Science were searched through 31 March 2025. Studies using histopathologic or cytologic reference standards were included. Pooled estimates of sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were calculated using random-effects models. Subgroup analyses and meta-regression were performed to explore potential effect modifiers. Studies evaluating contrast-enhanced computed tomography were included in the qualitative synthesis but were not incorporated into the quantitative meta-analysis.ResultsA total of 59 studies were included in the systematic review. Among these, 54 CEUS studies provided sufficient data for quantitative synthesis. CEUS demonstrated pooled sensitivity of 78.6% and specificity of 82.6%, with an overall diagnostic accuracy of 81.6%. Subgroup analyses indicated that examiner experience significantly influenced diagnostic performance, with higher sensitivity observed in studies involving more experienced operators. Meta-regression did not identify statistically significant independent associations between examined covariates and diagnostic outcomes.ConclusionThe available literature indicates that CEUS demonstrates favorable diagnostic performance for differentiating benign from malignant thyroid nodules. Further prospective studies using standardized imaging protocols and reporting frameworks are needed to better define the role of CEUS in thyroid nodule evaluation.