Ultrathin Versus Conventional Bronchoscopy for Diagnosing Peripheral Lung Lesions

The smaller diameter of ultrathin bronchoscopy (UTB) likely offers a diagnostic advantage over conventional bronchoscopy (CB), and conventional bronchoscopy with a guide sheath (CB-GS), by allowing deeper and more precise access to peripheral regions of the lungs, says a new study published in the journal Expert Review of Respiratory Medicine.1

This systematic review and meta-analysis compared UTB with CB, including CB combined with guiding modalities, for diagnosing peripheral pulmonary lesions. A comprehensive literature search was conducted to identify studies comparing UTB and CB, focusing on outcomes such as diagnostic yield, procedure duration, complication rates, pathological findings, and lesion size. Eleven studies involving 2640 patients were included in the final analysis.

UTB demonstrated a significantly higher diagnostic yield (70.5% versus 57.6%), especially when used with radial endobronchial ultrasound (rEBUS) and fluoroscopy. It also had a shorter operative time than CB-GS (p = 0.007) and showed superior performance in detecting malignant tumors, such as adenocarcinoma and metastatic cancers.

Although UTB had a higher complication rate, the difference was not statistically significant (p = 0.37). While both UTB and CB were comparable in diagnosing benign lesions, UTB outperformed CB in all lesion size categories.

The study suggests the use of UTB as a preferred and efficient modality for diagnosing peripheral pulmonary lesions. Given its demonstrated superiority across all lesion size categories and enhanced performance in detecting malignancies, UTB should be integrated into diagnostic protocols, particularly in cases with suspected malignancy.

Reference

1.   Jiaping Liu, et al. Ultrathin bronchoscopy versus conventional bronchoscopy in the diagnosis of peripheral pulmonary lesions: a systematic review and meta-analysis. Expert Rev Respir Med. 2025 May;19(5):461-473. doi: 10.1080/17476348.2025.2481959.