Ramyar Mahdavi, MD, interventional pulmonologist at Adventist Health Glendale, discusses a complex case of adenocarcinoma that evaded diagnosis elsewhere.
I'm Doctor Ramya Madevi. I'm interventional pulnologist. In July 2024, I came to Adventist Health to start the interventional pulmonology program. If I want to categorize the. The work that intervention and interventional pulnologist can do for the patient and not only for the patients for referring physicians in different specialties like internal medicine like oncology, medical oncology, radiation oncology, thoracic surgery, and pulmonologists that they refer their patient to us for two different reasons diagnostic procedures and therapeutic procedures. For diagnostic procedures I would categorize in 2 or 3 different kinds of diagnostic procedures diagnostic of airway diseases with rigid bronchoscopy, uh, doing biopsy from the airway, uh, doing biopsy from the pleural space with the medical trochoscopy which uh can be done under even conscious sedation, not general anesthesia. And for the therapeutic purposes we can categorize in three different categories airway diseases, lung pranchial diseases, or plural space diseases. I remember a case that I performed as a diagnostic procedure with robotic bronchoscopy but for the diagnosis of lung cancer. That patient was a 68 year old female, uh, with no smoking history, had a very small nodule in the right upper lobe. It was, if I remember, 4 millimeters or 5 millimeters, and it was grand glass opacity nodule. It has been grown for, I would say 1 or 2 millimeters. Over a 2 year period of time. The pulologist that taking care of the patient sent the patient for a CT guided biopsy, and it was negative for cancer, so the patient was happy that, OK, I don't have cancer. Uh, another CAT scan in 6 months performed and the granular opacity increased just 1 millimeter in size. The patient referred to me. We did robotic bronchoscopy and, uh, we get a good biopsy, very, very precise biopsy enough for detecting all of the genomics for pathology pathologic evaluation. Because we use cryo biopsy when we do robotic bronchoscopy, meaning a good chunk of tissue for pathologists. To diagnose the lung cancer or any other uh problems with the lung that came off adenocarcinoma of the lung uh we did the EBAS or endoronchial ultrasound for staging of lung cancer at the same time in same session of anesthesia and it came in 0, meaning that no lymph nodes were was involved in the with the cancer so the time frame from the. Basically when I saw the patient for the first time in my office when the patient referred to me uh with the and and getting the diagnosis basically meaning that performing the uh robotic bronchoscopy and having the pathology results was uh. Around 10 days we referred the patient after this diagnosis to the thoracic surgeon within our health system and got a surgery, removal of that part of the lung and the patient was cured. If we didn't diagnose this lung cancer despite the fact that she had a biopsy before with the CT guided and she was happy that, OK, I don't have lung cancer because the biopsy was negative, but with our biopsy, which was very precise, we diagnosed lung cancer in the very early stage and the patient was cured.
