Diagnostic Value of Rapid On‐Site Evaluation During Endobronchial Ultrasound‐Guided Bronchoscopy for Peripheral Pulmonary Lesions: A Meta‐Analysis

OBJECTIVE: Screening high-risk populations for lung cancer with low-dose computed tomography (LDCT) reduced lung cancer mortality. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a well-established technique for the diagnosis of peripheral pulmonary lesions (PPLs) during bronchoscopy. Moreover, rapid on-site evaluation (ROSE) improves the diagnostic yield and accuracy of EBUS-TBNA. Nevertheless, it remains unclear whether ROSE is an efficacious diagnostic tool for PPLs. Therefore, this meta-analysis aimed to assess the diagnostic accuracy of ROSE for PPLs during EBUS bronchoscopy. METHODS: A comprehensive search of the PubMed, Embase, and Cochrane Library databases was conducted to identify studies that evaluated the diagnostic accuracy of ROSE for PPLs during EBUS bronchoscopy. Our study included articles that evaluated the performance of ROSE against a reference standard. Additionally, we examined journal articles that provided sufficient data to construct a 2 × 2 table on a per-lesion basis. To estimate the overall sensitivity and specificity, a meta-analysis was conducted using a bivariate random-effects model. RESULTS: Thirteen studies with 1841 PPLs were included. The meta-analysis yielded a pooled sensitivity of 88.1% and a pooled specificity of 91.7%. A subgroup analysis for studies that enrolled patients who underwent CT produced a pooled sensitivity of 94.2% and a pooled specificity of 96.9%. Furthermore, accuracy of ROSE sampled by EBUS using a guide sheath showed a pooled sensitivity of 88.5%. CONCLUSION: The ROSE technique demonstrated high sensitivity and specificity for lung cancer detection during EBUS bronchoscopy for PPLs. Furthermore, ROSE might have higher sensitivity among patients who underwent CT.