Advice

Expert comments

Expert comments

Comments on this technology were invited from clinical experts working in the field and relevant patient organisations. The comments received are individual opinions and do not represent NICE's view.

Three experts were familiar with or had used this technology before.

Level of innovation

One expert considered the technology to be novel, and another expert thought the technology was different to standard care (CT‑guided trans-thoracic needle biopsy) because Archimedes provides navigation from inside rather than the outside. All experts were aware of the superDimension Navigation System, an alternative technology available in the NHS (see NICE's medtech innovation briefing on superDimension Navigation System).

Potential patient impact

One expert considered the Archimedes System useful, and thought it would improve accuracy and yield in diagnosing lung diseases, particularly peripheral lung lesions that are small or awkward to sample. The expert thought that using the system could have the potential to lead to fewer complications compared with CT‑guided biopsy.

All experts agreed that the people most likely to benefit from the technology were those who could not have CT‑guided transbronchial needle biopsy because the position of the lesion made it too risky. One expert thought that other people who would benefit were those:

  • at high risk of pneumothorax, for example, if they have significant emphysema or advanced interstitial lung disease

  • who have a lung nodule so deep in the lung that a trans-thoracic needle would have to travel some distance from the pleura.

Potential system impact

The experts generally agreed that the technology would shorten the current pathway by avoiding unnecessary tests.

The procedure uses fewer hospital resources than an inpatient stay and takes less time than an invasive surgical biopsy. It can also free up radiology resources for other patient workloads. The average cost per procedure may be reduced if the procedure is done under sedation in a bronchoscopy suite. Two experts thought there would be little change to current facilities or infrastructure. But the experts indicated the potential need to increase capacity in the bronchoscopy unit. For instance, surgical support and general anaesthesia may be needed in some procedures. The procedure may be more likely to be performed in specialist centres. Experts thought that training would be needed to use the technology and to do the procedure.

General comments

All experts considered that Archimedes would be used as an add-on to current CT‑guided biopsy, and one noted that patients do need an additional CT scan to plan the procedure. None of the experts was aware of any safety issues but 2 said data collection on the safety of using the technology is ongoing. One expert thought patient selection for the procedure would be important, and this should be based on experienced healthcare professionals' assessment of when the technology is most suitable for people. The main barrier to adoption identified by 2 experts was the cost of the technology. Two experts thought more studies were needed to improve the current evidence base, especially a study comparing the accuracy of the technology with that of CT‑guided biopsy or other bronchoscopy in the NHS.