Circulating tumor DNA (ctDNA) is evolving into a promising non-invasive approach for the detection of ALK rearrangement. This meta-analysis was designed to determine the diagnostic value of ctDNA for ALK rearrangement in lung cancer patients.We performed a comprehensive publication search in Pubmed, Cochrane library, and Web of Science to identify the potentially relevant studies. Eligible studies were pooled to calculate the overall sensitivity, specificity, and diagnostic odds ratio (DOR). The area under the receiver operating-characteristic curve (AUC) was used to evaluate the overall diagnostic performance.Thirteen eligible articles involving fourteen studies were identified in our meta-analysis, with a total of 1,138 participants. The pooled sensitivity, specificity, DOR, and AUC of ctDNA for ALK status detection were 0.61 (95% CI: 0.49, 0.72), 1.00 (95% CI: 0.98, 1.00), 188.19 (95% CI: 30.79, 1150.05) and 0.92, respectively. No publication bias was found among these studies (P = 0.42).Detecting ALK rearrangement in ctDNA demonstrates adequate diagnostic accuracy and could serve as a highly specific test in lung cancer patients.Copyright: © 2025 Sun et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.