BACKGROUND: Previous studies have indicated that clinical and imaging features may assist in distinguishing between benign and malignant solid lung nodules. Yet, the specific characteristics in question continue to be debated. This meta-analysis aims to identify risk factors for malignant solid lung nodules, thereby supporting informed clinical decision-making. METHODS: A comprehensive search of databases including PubMed, Embase, Web of Science, Cochrane Library, Scopus, Wanfang, CNKI, VIP, and CBM was conducted up to October 6, 2024. Only publications in Chinese or English were considered. Data analysis was performed using Stata 16.0 software. RESULTS: This analysis included 32 studies, comprising 7758 solid pulmonary nodules, of which 3359 were benign and 4399 were malignant. It was found that the incidence of spiculate signs in malignant solid pulmonary nodules (MSPN) was higher than in benign solid pulmonary nodules (BSPN) [OR = 3.06, 95% CI (2.35, 3.98), P <
0.05. Additionally, increases were observed in the incidences of vascular convergence[OR = 16.57, 95% CI (8.79, 31.24), P <
0.05], lobulated signs [OR = 5.17, 95% CI (3.83, 6.98)], air bronchogram sign[OR = 2.96, 95% CI (1.62, 5.41), P <
0.05], pleura traction sign [OR = 2.33, 95% CI (1.65, 3.29), P <
0.05], border blur [OR = 2.94, 95% CI (1.47, 5.85), P <
0.05], vacuole signs [OR = 5.25, 95% CI (2.66, 10.37), P <
0.05], and family history of cancer [OR = 3.85, 95% CI (2.43, 6.12), P <
0.05] compared to BSPN. Older age[OR = 1.06, 95% CI (1.04, 1.07), P <
0.05], higher prevalence in females [OR = 2.98, 95% CI (2.27, 3.92), P <
0.05], larger nodule diameters [OR = 1.25, 95% CI (1.13, 1.38), P <
0.05], and lower incidence of calcification [OR = 0.21, 95% CI (0.10, 0.48), P <
0.05] were also associated with MSPN. No significant differences were found between MSPN and BSPN regarding CEA and emphysema (all P >
0.05). CONCLUSIONS: This meta-analysis highlights that spiculate sign, vascular convergence sign, lobulated sign, diameter, border blur, vacuole sign, age, gender, family history of cancer, pleura traction, air bronchogram sign, and calcification are significant markers for predicting malignancy in SPNs, potentially influencing clinical management. However, further well-designed, large-scale studies are needed to confirm these findings.