Guided bronchoscopy falls short of improving diagnostic yield for peripheral pulmonary lesions

Advances in bronchoscopic technology have been increasingly applied for diagnosing peripheral pulmonary lesions, but a recent study has found that such advances have not translated to improved diagnostic yield.

A meta-analysis published in 2012 reported that guided bronchoscopy had a pooled diagnostic yield of 70 percent, but recent publications have documented yields as low as 40 percent and as high as 90 percent.

Researchers conducted an updated meta-analysis of studies evaluating the diagnostic yield of different bronchoscopic technologies utilized to diagnose peripheral pulmonary lesions. They searched multiple online databases for relevant studies and extracted data on number of lesions, type of technology utilized, overall diagnostic yield, yield by size, and adverse events.

Study quality was evaluated using the QUADAS-2 assessment tool, while meta-analytic techniques facilitated synthesis of findings across all studies.

The meta-analysis included 126 studies, which involved a total of 16,389 lesions. Diagnostic yield before 2012 (39 studies, 3,052 lesions; yield 70.5 percent) did not significantly differ from that after 2012 (87 studies, 13,535 lesions; yield 69.2 percent; p>0.05). Likewise, the diagnostic yield showed not much change when comparing different technologies.

Of note, studies with low risk of overall bias reported a lower diagnostic yield than studies with high risk of bias (66 percent vs 71 percent; p=0.018).

Factors associated with significantly higher diagnostic yield included lesion size >2 cm, presence of bronchus sign, and reports with a high prevalence of malignancy in the study population. There was significant between-study heterogeneity observed (p<0.0001).