{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T13:04:31Z","timestamp":1767791071912,"version":"3.49.0"},"reference-count":46,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T00:00:00Z","timestamp":1767744000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Introduction: Ultrasound elastography is increasingly used across medical imaging, yet its role in thoracic disease remains poorly defined. While both transthoracic ultrasonography (TUS) and endobronchial ultrasound (EBUS) offer real-time assessment of pleural and pulmonary structures, the diagnostic and clinical value of elastography in this context remains uncertain. Materials and Method: A systematic search of MEDLINE, EMBASE, and the Cochrane Library was conducted according to PRISMA guidelines (April 2023; updated January 2025). Original studies evaluating transthoracic or endobronchial elastography for pleural or pulmonary conditions were included. Data extraction and quality assessment were performed independently by three reviewers, with QUADAS-2 used to evaluate risk of bias. Results: Thirty studies met inclusion criteria. Twenty-eight evaluated TUS elastography and two examined EBUS. Shear wave elastography was most frequently applied, particularly for differentiating malignant from benign pleural effusion or subpleural lesions. Surface wave elastography demonstrated consistently higher stiffness values in patients with interstitial lung disease compared with healthy controls, correlating with radiological and functional disease severity. Elastography-guided pleural biopsy improved diagnostic yield compared with conventional ultrasound-guided biopsy. Overall, substantial methodological variation existed among scanning techniques, elastography modalities, reporting methods, and diagnostic thresholds, limiting cross-study comparison. Conclusions: Ultrasound elastography shows promise for evaluating pleural effusion and pulmonary lesions, procedural guidance, and interstitial lung disease possibly improving diagnostic possibilities with bedside evaluation and reducing patient exposure to radiation. However, methodological variation and limited high-quality evidence preclude clinical implementation. Standardized acquisition protocols and multicentre validation studies are necessary to define its diagnostic utility in thoracic imaging.<\/jats:p>","DOI":"10.3390\/cancers18020190","type":"journal-article","created":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T08:26:56Z","timestamp":1767774416000},"page":"190","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Application of Transthoracic and Endobronchial Elastography\u2014A Systematic Review"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-5110-0858","authenticated-orcid":false,"given":"Christian","family":"Kildegaard","sequence":"first","affiliation":[{"name":"Department of Respiratory Medicine, Odense University Hospital, 5000 Odense, Denmark"},{"name":"Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rune W.","family":"Nielsen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Odense University Hospital, 5000 Odense, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian B.","family":"Laursen","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Odense University Hospital, 5000 Odense, Denmark"},{"name":"Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark"},{"name":"Centre for Advanced Lung Cancer Diagnostics (CALU), Odense University Hospital, 5000 Odense, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ariella Denize","family":"Nielsen","sequence":"additional","affiliation":[{"name":"Department of Infectious Medicine, Odense University Hospital, 5000 Odense, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9103-9549","authenticated-orcid":false,"given":"Amanda D.","family":"Juul","sequence":"additional","affiliation":[{"name":"Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark"},{"name":"Centre for Advanced Lung Cancer Diagnostics (CALU), Odense University Hospital, 5000 Odense, Denmark"},{"name":"Department of Internal Medicine, Odense University Hospital, 5700 Svendborg, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tai Joon","family":"An","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yeouido St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dinesh","family":"Addala","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 7LE, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0389-5386","authenticated-orcid":false,"given":"Casper","family":"Falster","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Odense University Hospital, 5000 Odense, Denmark"},{"name":"Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e200564","DOI":"10.1148\/ryct.2021200564","article-title":"Lung Ultrasound: The Essentials","volume":"3","author":"Marini","year":"2021","journal-title":"Radiol. 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