Objective To evaluate the significance of the ultrasound elastography (UE) strain ratio (SR) in the diagnosis of breast nodule by meta-analysis. Methods A computer-based online search was conducted in PubMed, The Cochrane Library (Issue 6, 2017), EMbase, CNKI, VIP, CBM, WanFang data databases, and so on (establishment time to June 2017), to collect the relevant diagnostic trials of the SR for breast nodules. Two reviewers independently screened literatures, extracted data, and evaluated the methodological quality of included studies. The meta-analysis was performed by using Stata 12.0 and Meta-Disc 1.4 software, and the combined indexes included sensitivity (Sen), specificity (Spe), positive likelihood ratio (LR+), negative likelihood ratio (LR–), and diagnostic odds ratio (DOR). Results A total of 26 studies were finally included. The results of meta-analysis showed that, the pooled Sen, Spe, LR+, LR–, and DOR was 0.88 (95% CI was 0.87 to 0.90), 0.85 (95% CI was 0.84 to 0.86), 6.66 (95% CI was 5.26 to 8.43), 0.14 (95% CI was 0.11 to 0.17), and 53.37 (95% CI was 34.96 to 81.49), respectively, P<0.000 1. Conclusion SR has high diagnostic accuracy in the differential diagnosis of benign and malignant breast nodules, it is worthy of widely utilized in the clinic.