Efficacy and safety of cone-beam computed tomography-guided bronchoscopy for peripheral pulmonary lesions: a systematic review and meta-analysis

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Key findings

• Cone-beam computed tomography (CBCT) guided bronchoscopy for peripheral pulmonary lesions (PPLs) is a safe technique with high diagnostic yield (DY), especially used with robotic-assisted navigation bronchoscopy (RAB). Lesion size >20 mm, presence of bronchus sign, and solid lesions may serve as predictors for higher DY in CBCT-guided bronchoscopy.

What is known and what is new?

• The DY of CBCT-guided bronchoscopy for PPLs was ranging from 45% to 93%. Previous study reported that DY of lesions >20 mm was higher than that of lesions ≤20 mm, and the DY of lesions with bronchus sign was higher than that of lesions without bronchus sign in guided bronchoscopy.

• Our meta-analysis showed that the overall pooled DY of CBCT-guided bronchoscopy was 80.2% [95% confidence internal (CI): 76.0–84.1%]. Subgroup analysis showed that the DY was highest when CBCT was used with RAB (pooled DY 87.5%; 95% CI: 81.5–92.4%). Lesion size >20 mm, presence of bronchus sign and solid lesions were associated with significant increase in the odds of diagnosis with CBCT-guided bronchoscopy. Pooled adverse event rate was 2.3% (95% CI: 1.2–3.6%).

What is the implication, and what should change now?

• CBCT-guided bronchoscopy is effective and safe in the diagnosis of PPLs. Lesion size >20 mm, presence of bronchus sign, and solid lesions may serve as predictors for higher DY in CBCT-guided bronchoscopy. However, more clinical studies are needed in the future to confirm or correct our results.

Publication: Li Z, Xu S, Zhang Y, Shi J. Efficacy and safety of cone-beam computed tomography-guided bronchoscopy for peripheral pulmonary lesions: a systematic review and meta-analysis. J Thorac Dis 2025;17(2):551-563. doi: 10.21037/jtd-24-1224