What we looked at and why

SHTG recommendation

In response to an enquiry from the NHSScotland National Infrastructure Board

What were we asked to look at?

We were asked to review the evidence on the clinical effectiveness, cost effectiveness and safety of RAB for diagnosing lung lesions suspected of being cancer.

Why is this important?

A lung nodule biopsy is needed to accurately diagnose patients with suspected lung cancer. Conventional techniques are unable to reliably biopsy peripheral pulmonary lesions or nodules <20 mm in diameter.¹ Patients with these peripheral or small nodules who cannot get a biopsy-confirmed diagnosis may experience anxiety, disease progression or unnecessary aggressive treatments. The planned introduction of lung cancer screening in Scotland from 2027 is expected to increase the number of patients needing diagnostic biopsies of small pulmonary nodules, not all of which will be suitable for conventional biopsy procedures. RAB may be an option for obtaining biopsy-confirmed diagnoses for these patients. RAB is not currently available in NHSScotland.

What was our approach?

We reviewed the published literature on the clinical effectiveness, cost effectiveness, safety and patient experience of RAB for diagnosing lung cancer. We developed an exploratory economic model to gauge the likely cost effectiveness of introducing RAB in Scotland. A patient organisation submission was obtained from the Roy Castle Lung Cancer Foundation. More information about SHTG Recommendations is available on our website.

What next?

The NHSScotland National Infrastructure Board will use our advice to inform a decision on introducing RAB for diagnosing lung cancer in adults in Scotland.