Narrative review of diagnostic yield of navigational bronchoscopy for pulmonary nodules-a call for standardization.

Abstract

Background and objective: Lung cancer remains the leading cause of cancer-related mortality worldwide, with peripheral pulmonary lesions (PPLs) being increasingly identified through screening programs. Navigational bronchoscopy, including electromagnetic and robotic-assisted bronchoscopy, is pivotal for biopsying these lesions. However, inconsistent definitions of diagnostic yield (DY) across studies hinder accurate assessment of bronchoscopy performance. This narrative review aims to clarify current DY definitions and advocate for a standardized approach.

Methods: A narrative review of articles from January 2019 to July 2024 was conducted using PubMed, focusing on DY and its calculation in bronchoscopic procedures.

Key content and findings: This review highlights significant inconsistencies in DY definitions, with some studies including follow-up assessments and nonspecific benign (NSB) findings, while others only consider immediate specific benign (SB) and malignant results. These discrepancies result in wide-ranging reported DY values, from 26.7% to 97%. Additionally, the review underscores the importance of distinguishing between DY and diagnostic accuracy (DA), as they assess different aspects of procedural performance and should not be used interchangeably. Simulation studies also demonstrate that cancer prevalence and methodological differences in DY calculation substantially affect study outcomes. Standardizing DY as a measure based solely on immediate SB and malignant findings-without follow-up-would allow faster study times and for easier comparison across different studies. Reporting disease prevalence within the study population is highly relevant as higher prevalence may inflate reported DY values.

Conclusions: A standardized, strict definition of DY is crucial for accurately evaluating the diagnostic capacity of bronchoscopy. DY should not be confused with DA, as they measure distinct elements of performance. Adopting a strict definition of DY will enhance the comparability of study results, promote evidence-based decision-making, and help reduce unnecessary procedures while improving the reliability of diagnostic assessments in clinical practice.