Background: The diagnosis of tuberculous pleurisy is difficult and traditional methods are not always helpful. Many studies have focused on the tumor necrosis factor-alpha (TNF-alpha) assay in pleural effusion for the diagnosis of tuberculous pleurisy, but the results remain controversial. This meta-analysis was conducted to determine the overall diagnostic accuracy of TNF-alpha. Methods: Relevant studies were searched from PubMed, Embase, Web of Science, Chinese National Knowledge Infrastructure (CNKI). Wangfang. and Weipu. We pooled the published results and computed the accuracy measures, including sensitivity. specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR). Receiver operating characteristic curves (SROC) and the area under the curve (AUG) were used to summarize the overall test performance. Results: Twelve studies with 1022 patients met the inclusion criteria. The pooled sensitivity and specificity were 0.85 (95%CI, 0.81-0.89) and 0.80 (95% CI, 0.77-0.83) respectively. The area under the SROC curve was 0.89. Conclusions: The results of meta-analysis suggested that the TNF-alpha assay plays a vital role in the diagnosis of tuberculous pleurisy. whereas other test results or clinical findings should be interpreted together with the TNF-alpha assay to improve the overall diagnostic accuracy,