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This study aimed to evaluate the discrimination performance of ultrasound elastography (USE) in assessing PTC nodule for determination of cervical lymph node metastasis (CLNM).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>The protocol was pre-registered at (<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/osf.io\/r5tc8\" ext-link-type=\"uri\">https:\/\/osf.io\/r5tc8<\/jats:ext-link>). 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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Twenty-one studies were included involving 7559 patients; 2790 (36%) were positive for CLNM, while 4769 (63%) were negative. The pooled E<jats:sub>mean<\/jats:sub> values for positive and negative CLNM were 51.2k Pa (95% CI: 42.6 to 59.7) and 44.8\u00a0kPa (95% CI: 35.2 to 54.4), respectively. It represents an absolute increase of 6.14\u00a0kPa (95% CI: 2.70 to 9.59) in the metastatic group compared to the benign group. Additionally, the pooled E<jats:sub>max<\/jats:sub> value for positive and negative CLNM were 87.9\u00a0kPa (95% CI: 49.5 to 126.4) and 68.7\u00a0kPa (95% CI: 44.2 to 93.1), respectively. This corresponds to an absolute increase of +\u200919.57\u00a0kPa (95% CI: 2.96 to 36.18) in the metastatic group, representing a more dramatic elevation compared to E<jats:sub>mean<\/jats:sub> values. The thyroid nodule E<jats:sub>max<\/jats:sub> and E<jats:sub>mean<\/jats:sub> were significantly higher for positive CLNM of +\u200927.5% (95% CI: 10.5\u201344.5%) and +\u200912.9% (95% CI: 5.1\u201320.7%) respectively. Combining USE with conventional ultrasound improved differentiation accuracy, achieving a sensitivity of 80% (95% CI: 62\u201390%), specificity of 79% (95% CI: 70\u201385%), and an AUC of 0.85 (95% CI: 0.81 to 0.88).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>USE parameters demonstrated potential as a discrimination tool for the preoperative assessment of CLNM, particularly when combined with conventional ultrasound, which enhances its performance.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Clinical trial number<\/jats:title>\n            <jats:p>N\/A.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s12880-025-01858-z","type":"journal-article","created":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T09:16:56Z","timestamp":1755767816000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Determination of lymph node metastasis using quantitative ultrasound elastography of papillary thyroid carcinoma nodule: a systematic review and meta-analysis"],"prefix":"10.1186","volume":"25","author":[{"given":"Alisa","family":"Mohebbi","sequence":"first","affiliation":[],"role":[{"role":"author","vocab":"crossref"}]},{"given":"Saeed","family":"Mohammadzadeh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocab":"crossref"}]},{"given":"Mohammad","family":"Ghaffari","sequence":"additional","affiliation":[],"role":[{"role":"author","vocab":"crossref"}]},{"given":"Afshin","family":"Mohammadi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocab":"crossref"}]},{"given":"Nathalie J.","family":"Bureau","sequence":"additional","affiliation":[],"role":[{"role":"author","vocab":"crossref"}]},{"given":"Ali Abbasian","family":"Ardakani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocab":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,8,21]]},"reference":[{"key":"1858_CR1","doi-asserted-by":"publisher","unstructured":"Masui T, Adachi S, Uemura H, Kimura T, Kitahara T. 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