Since the diagnostic accuracy of conventional examinations for malignant pleural effusion (MPE) is limited, a number of studies have investigated the utility of pleural vascular endothelial growth factor (VEGF) in the diagnosis of MPE. The present meta-analysis aimed to determine the overall accuracy of a VEGF test in the diagnosis of MPE. A systematic review of studies published in English was conducted and the data concerning the accuracy of pleural VEGF assays in the diagnosis of MPE were pooled with random effects models. The overall test performance was summarized using receiver operating characteristic curves. Ten studies, based on 1,025 patients, met the inclusion criteria for the meta-analysis and the summary estimates for VEGF in the diagnosis of MPE were: sensitivity 0.75 [95% confidence interval (CI), 0.72-0.79], specificity 0.72 (95% CI, 0.68-0.76), positive likelihood ratio 2.94 (95% CI, 1.97-4.41), negative likelihood ratio 0.38 (95% CI, 0.27-0.51) and diagnostic odds ratio 9.05 (95% CI, 4.60-17.80). The summary receiver operating characteristic curve indicated that the maximum joint sensitivity and specificity was 0.75; the area under the curve was 0.82. Our findings suggest that the determination of pleural VEGF may improve the accuracy of MPE diagnosis, while the results of VEGF assays should be interpreted in parallel with conventional test results and other clinical findings.