CHARLESTON, SC — Even though guided bronchoscopy is being used more and more to diagnose peripheral pulmonary lesions (PPL), questions continue about the procedure’s diagnostic yield.
A new study in Chest cites a meta-analysis published in 2012 which demonstrated a pooled diagnostic yield of 70%. A research team led by the Medical University of South Carolina in Charleston and the including participation from the Ralph H. Johnson Veterans Affairs Hospital, Charleston, SC, pointed out that recent publications have documented yields as low as 40% and as high as 90%.1
That all led to the question whether the diagnostic yield of guided bronchoscopy in patients with peripheral pulmonary lesions has improved over the past decade. To help answer that question, the study team conducted a comprehensive search of studies evaluating the diagnostic yield of differing bronchoscopic technologies used to reach PPLs. The focus was on number of lesions, type of technology utilized, overall diagnostic yield and yield by size.
Included were 16,389 lesions from 126 studies. Researchers found no significant difference in diagnostic yield prior to 2012 (39 studies, 3052 lesions; yield 70.5%) versus 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,” the authors advised.
Researchers determined that studies with low risk of overall bias had a lower diagnostic yield than those with high risk of bias (66% versus 71%, respectively; (p = 0.018). Associated with significantly higher diagnostic yield were lesion size >2cm, presence of bronchus sign and reports with a high prevalence of malignancy in the study population, according to the study, which added, “Significant (p<0.0001) between-study heterogeneity was also noted.”
“Despite the reported advances in bronchoscopic technology to diagnose peripheral pulmonary lesions, the diagnostic yield of guided bronchoscopy has not improved,” the authors concluded.
- Nadig TR, Thomas N, Nietert PJ, Lozier J, et. al. Guided bronchoscopy for the evaluation of pulmonary lesions: An updated meta-analysis. Chest. 2023 Jan 11:S0012-3692(23)00030-2. doi: 10.1016/j.chest.2022.12.044. Epub ahead of print. PMID: 36640994.
