What is the key question?

• Has the diagnostic yield of guided bronchoscopy in patients with peripheral pulmonary lesions (PPLs) improved over the past decade?

What is the bottom line?

• Guided bronchoscopy is increasingly used to diagnose PPLs. A meta-analysis published in 2012 demonstrated a pooled diagnostic yield of 70%; however, recent publications have documented yields as low as 40% and as high as 90%.
• Authors conducted a comprehensive search of studies evaluating the diagnostic yield of differing bronchoscopic technologies used to reach PPLs. Meta-analytic techniques were used to summarize findings across all studies.
• A total of 16,389 lesions from 126 studies were included.
• There was no significant difference in diagnostic yield prior to 2012 (39 studies; 3,052 lesions; yield 70.5%) vs after 2012 (87 studies; 13,535 lesions; yield 69.2%) (P > 0.05). Additionally, there was no significant difference in yield when comparing different technologies.
• Studies with low risk of overall bias had a lower diagnostic yield than those with high risk of bias (66% vs 71%, respectively; P=0.018).
• Lesion size > 2 cm, presence of bronchus sign, and reports with a high prevalence of malignancy in the study population were associated with significantly higher diagnostic yield.

Why read on?

• Despite the reported advances in bronchoscopic technology to diagnose PPLs, the diagnostic yield of guided bronchoscopy did not appear to have improved.