Diagnostic Accuracy of Elastography Combined with TI-RADS for Differentiating Benign and Malignant Thyroid Nodules: A Systematic Review and Meta-Analysis

Abstract

The distinction between benign and malignant thyroid nodules remains a diagnostic challenge. Sonographic elastography has emerged as a promising diagnostic adjunct to augment overall diagnostic accuracy. The aim of this study was to determine whether the combination of ultrasound elastography and the Thyroid Imaging Reporting and Data System (TI-RADS) enhances diagnostic accuracy in distinguishing benign from malignant thyroid nodules. This systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, with the protocol registered in the PROSPERO database (ID: CRD420261333246). Electronic databases searched included PubMed, Web of Science, Ovid, and Google Scholar, covering studies from January 2021 to January 2026. Study quality was assessed using the QUADAS-2 tool. A total of 10 studies involving 3556 patients and 3646 thyroid nodules were included. The Thyroid Imaging Reporting and Data System alone demonstrated sensitivity of 0.84 and specificity of 0.74 (area under the curve [AUC] = 0.88), while elastography alone achieved specificity of 0.86 with sensitivity of 0.84 (AUC = 0.89). The combined approach yielded the highest sensitivity of 0.88, specificity of 0.87, diagnostic odds ratio (DOR) = 29.14, and AUC = 0.90. The integration of TI-RADS and elastography contributes significantly to improved diagnostic accuracy with a reduction in false-positive outcomes, thereby supporting a selective and evidence-based biopsy strategy.