In medicine we make decisions and then live by it. The decisions are made based on our understandings of the tests and not all are available for all of us .Could AI make a different outcome - I don't know . I don't think so. So most of the time we are correct and sometimes we are not. So the new tests are developed .That brings me to the story for the today.
I saw this lady several years ago. She had mild asthma and she came to me and we did tests and then started her on medicines and she did well. But ew people have this thinking that they can 'cure' the decision and then they will not need medicines . It does not happen in many conditions, but still some think it in that way. So she went to allergist and he did tests and then continued the same meds. But she did not come back to me. She was stable and then after 3-4 years she had shortness of breath and she was admitted and I was called. She had a clot in lungs and that made her short of breath. The asthma was stable . But when a CT scan was done, she had not only pulmonary embolism, but also ha =d a spot on the lung . This was not seen before and she was concerned. She has been nonsmoker and had new clot. So I decided that we will do the out patient work up. But at this time we wanted to have her treatment for the clot. The oncologist was also called and they concentrated on the clot rather that the spot on the lung. She was discharged and then we did the work up as out patient.
She was treated with blood thinner /anticoagulation. She had follow up with her cancer doctor and no new tests were done .She came to me after 4-6 weeks . I ordered a PET SCAN As I have mentioned in my previous blogs the PET scan shows metabolic activity of the cells and is good in 85 % cases for picking up cancer. We decided to do bronchoscopy and we had to hold the blood thinner for 3 days and then the bronchoscopy was OK. We had done breathing test and I had asked her to see a chest surgeon too. The PET scan was showing that the spot on the lung was hot -it had pick up and so I had her see the thoracic surgeon. He saw her and no decision was made. She came to see me and by then it was almost 6-7 weeks from the PET scan. I saw her I was expecting that the surgeon would have done the surgery and then I will see her. SO when I saw her in office and no surgery was planned, I called the surgeon and scheduled her for new CT scan . The surgeon called me and he could not tell me why no surgery was planned , but he agreed that the spot needed to come out. The new Ct scan was done and she had the same spot with may be minimal increase.
The surgery was done and - and - there was no CANCER. It was a infarct related to the clot. With the clot part of lung had infarct and bleeding and so that did not get better with time. But it was not cancer.
So the decision made based on PET scan was correct , but the Good news was that there was no cancer and Bad news was that she had surgery- a invasive procedure .
We have some new tests - CTDNA - circulating tumor DNA, Nodify etc. . We check the DNA of the cancer cells from simple blood test , we have antibody for cells and protein associated with the cancer etc. But NONE is 100% . Hope we will have it one day.
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