Ultrathin bronchoscopy versus conventional bronchoscopy in the diagnosis of peripheral pulmonary lesions: a systematic review and meta-analysis

Ultrathin bronchoscopy (UTB) is commonly used to diagnose peripheral pulmonary lesions due to its small diameter. However, there is no consensus on its comparison with conventional bronchoscopy (CB) combined with various guiding modalities. A comprehensive literature search was performed to identify studies comparing UTB and CB, extracting data on diagnostic yield, operating time, complications, pathological diagnoses, and lesion size. Protocol registration: identifier CRD42024554649. PRISMA guidelines were followed. This meta-analysis included 11 studies with 2,640 patients. UTB demonstrated a significantly higher diagnostic yield (70.5% vs. 57.6%, <i>p</i> = 0.005), particularly with rEBUS and fluoroscopy (<i>p</i> = 0.02). UTB had a higher complication rate, but the difference was not significant (<i>p</i> = 0.37). It also had a shorter operative time than CB-GS (<i>p</i> = 0.007). UTB showed a significant advantage in diagnosing malignant tumors, especially adenocarcinoma and metastatic cancer (<i>p</i> = 0.02, <i>p</i> = 0.03). Both techniques were comparable in diagnosing benign conditions, but UTB outperformed CB in all lesion size categories (<i>p</i> &lt; 0.01). UTB’s smaller diameter likely provides a diagnostic advantage over CB and CB-GS by enabling deeper and more accurate access to peripheral lung regions.