Abstract: Background: To investigate the diagnostic value of computed tomography (CT)-guided aspiration biopsy combined with rapid field evaluation for pulmonary lesions. Methods: The PubMed and EMBASE databases were searched systematically for studies related to the diagnosis of lung lesions by CT-guided puncture biopsy combined with a rapid on-site indexed through October 2022. The updated Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool was applied as the main method to assess the risk of bias and applicability of the studies. Meta-analysis software was used to perform heterogeneity tests on the data. Based on the heterogeneity results, the appropriate effect model was selected to calculate the overall sensitivity, specificity, and diagnostic odds ratio (DOR), and to plot the summary receiver operating characteristic (SROC) curve, forest plot, and funnel plot. The results of the analysis of six studies (n=951) using a random-effects model showed pooled sensitivity, specificity, and diagnostic odds ratio with 95% confidence intervals of 94%, 95%, and 159.05, respectively, with an SROC AUC of 0.98. Further analysis of the four studies that established control groups showed that the sampling adequacy and diagnostic accuracy in the ROSE group were 12% and 13% higher than those in the non-ROSE group. In conclusion, CT-guided puncture biopsy combined with rapid on-site evaluation is a practical and feasible method for diagnosing pulmonary lesions and can be used as an important clinical diagnostic method.