Diagnostic performance of thoracic ultrasound and shear wave elastography in detecting malignant pleural effusion: a comprehensive systematic review and meta-analysis of different ultrasonographic signs.
22 affiliations
- 1The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- 2These authors contributed equally to this work.
- 3Ibrahim Tirichine Public Hospital, Blida, Algeria.
- 4Blida University 01, Blida, Algeria.
- 5Department of Radiology, Stanford Medicine, Stanford, CA, USA.
- 6Faculty of Medicine, Sohag University, Sohag, Egypt.
- 7University of Nouakchott Al Aasrya, Faculty of Medicine, Nouakchott, Mauritania.
- 8Pleural Medicine and Clinical Ultrasound Unit, Department of Internal Medicine, Arnau de Vilanova University Hospital, IRBLleida, Lleida, Spain.
- 9Respiratory Research Unit PLUZ, Department of Respiratory Medicine, Zealand University Hospital, Naestved, Denmark.
- 10Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.
- 11Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark.
- 12Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
- 13Respiratory Department, Northumbria Health Care NHS Foundation Trust, Newcastle, UK.
- 14Department of Radiology, Stanford Medicine, Stanford, CT, USA.
- 15Faculty of Medical Technology, University of Tripoli, Tripoli, Libya.
- 16City University of New York Graduate School of Public Health and Health Policy, New York, NY, USA.
- 17Faculty of Medicine, Foča, University of East Sarajevo, Lukavica, Bosnia and Herzegovina.
- 18Centre for Innovative Pleural Research, North Metro Health Services, and Institute for Respiratory Health and University of Western Australia, Perth, Australia.
- 19Faculty of Medicine, University of Tripoli, Tripoli, Libya.
- 20College of Medicine, Korea University, Seoul, South Korea.
- 21Oxford Respiratory Trials Unit, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
- 22Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Abstract
Background
Malignant pleural effusion (MPE) greatly influences clinical management and therapeutic decision-making in patients with cancer. Accurate differentiation between MPE and non-MPE is therefore essential. This study aimed to evaluate the diagnostic accuracy of traditional ultrasonographic signs and ultrasound findings of adjacent thoracic structures in identifying MPE.Methods
PubMed, Scopus, Web of Science and Embase were searched until 2 May 2025 to identify studies evaluating the diagnostic accuracy of ultrasonographic signs using traditional ultrasound (TrUS) and shear wave elastography (SWE) for detecting MPE. Pooled sensitivity, specificity, diagnostic odds ratio, predictive values and likelihood ratios were estimated using a random-effects model.Results
10 studies fulfilled the eligibility criteria, including nine evaluating TrUS and three investigating SWE. Several ultrasonographic signs were highly specific for MPE, including pleural nodules (99%), diaphragmatic nodules (96%) and pleural thickening (93%). Concomitant chest wall invasion, hepatic metastasis and lung consolidation showed near-absolute specificity (99-100%). Nevertheless, the sensitivity of these signs did not exceed 60%. Meanwhile, SWE showed balanced diagnostic performance, with sensitivity ranging from 76.36% to 100% and specificity ranging from 59.09% to 94.40%, depending on the cut-off values used.Conclusion
TrUS can be considered in the working diagnosis of MPE, as pleural and diaphragmatic nodules, pleural thickening, chest wall invasion, lung involvement and liver metastasis show high specificity for MPE. However, further studies are needed to investigate the role of SWE in diagnosing MPE.
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BibTeX
@article{msherghi2026diagnostic,
title = {{Diagnostic performance of thoracic ultrasound and shear wave elastography in detecting malignant pleural effusion: a comprehensive systematic review and meta-analysis of different ultrasonographic signs.}},
author = {Ahmed Msherghi and Mohamed Smail Aissani and Ann N Leung and Kyrillos Mahrous Gerges and Mohamedhen Vall Nounou and José M Porcel and Uffe Bodtger and Christian B Laursen and Avinash Aujayeb and Bo Yan Fan and Eman Abdulwahed and Hajer Farrara and Munder Lateiresh and Y C Gary Lee and Muhammed Elhadi and Najib M Rahman},
journal = {ERJ open research},
year = {2026},
month = nov,
doi = {10.1183/23120541.01658-2025},
url = {https://europepmc.org/article/MED/43011977},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Diagnostic performance of thoracic ultrasound and shear wave elastography in detecting malignant pleural effusion: a comprehensive systematic review and meta-analysis of different ultrasonographic signs.
AU - Ahmed Msherghi
AU - Mohamed Smail Aissani
AU - Ann N Leung
AU - Kyrillos Mahrous Gerges
AU - Mohamedhen Vall Nounou
AU - José M Porcel
AU - Uffe Bodtger
AU - Christian B Laursen
AU - Avinash Aujayeb
AU - Bo Yan Fan
AU - Eman Abdulwahed
AU - Hajer Farrara
AU - Munder Lateiresh
AU - Y C Gary Lee
AU - Muhammed Elhadi
AU - Najib M Rahman
PY - 2026
DA - 2026/11/09
JO - ERJ open research
DO - 10.1183/23120541.01658-2025
UR - https://europepmc.org/article/MED/43011977
AB - Background Malignant pleural effusion (MPE) greatly influences clinical management and therapeutic decision-making in patients with cancer. Accurate differentiation between MPE and non-MPE is therefore essential. This study aimed to evaluate the diagnostic accuracy of traditional ultrasonographic signs and ultrasound findings of adjacent thoracic structures in identifying MPE.Methods PubMed, Scopus, Web of Science and Embase were searched until 2 May 2025 to identify studies evaluating the diagnostic accuracy of ultrasonographic signs using traditional ultrasound (TrUS) and shear wave elastography (SWE) for detecting MPE. Pooled sensitivity, specificity, diagnostic odds ratio, predictive values and likelihood ratios were estimated using a random-effects model.Results 10 studies fulfilled the eligibility criteria, including nine evaluating TrUS and three investigating SWE. Several ultrasonographic signs were highly specific for MPE, including pleural nodules (99%), diaphragmatic nodules (96%) and pleural thickening (93%). Concomitant chest wall invasion, hepatic metastasis and lung consolidation showed near-absolute specificity (99-100%). Nevertheless, the sensitivity of these signs did not exceed 60%. Meanwhile, SWE showed balanced diagnostic performance, with sensitivity ranging from 76.36% to 100% and specificity ranging from 59.09% to 94.40%, depending on the cut-off values used.Conclusion TrUS can be considered in the working diagnosis of MPE, as pleural and diaphragmatic nodules, pleural thickening, chest wall invasion, lung involvement and liver metastasis show high specificity for MPE. However, further studies are needed to investigate the role of SWE in diagnosing MPE.
SN - 2312-0541
ER -