A cough that wouldn’t go away led retired UAB instructor Ronnie Hubbard to visit his primary care provider. Though Hubbard is a non-smoker, a CT scan of his lungs was ordered, since he had no other symptoms that could be tied to an illness. The scan revealed a small but suspicious spot of tissue called a nodule.
Hubbard was referred to UAB St. Vincent’s East pulmonologist Brian Flanagan, M.D. He explained, in many cases, physicians may decide to monitor small nodules over time with follow-up imaging scans. And if a nodule remains stable, there may be no reason to take a sample of it for testing, known as a biopsy.
But Dr. Flanagan considered Hubbard’s entire medical history, including the fact that he’d survived colon cancer eight years earlier. And since Hubbard’s nodule grew from 6 mm to 8 mm in a few months, a biopsy was ordered.
“Any history of malignancy, you have to consider that, so your threshold for intervention is higher,” Dr. Flanagan said. “And because we have this new advanced bronchoscopy technology available to us, there was no reason to wait to investigate this further.”
Robotic-assisted bronchoscopy
Dr. Flanagan used advanced robotic-assisted bronchoscopy technology to reach the small nodule and obtain a tissue sample for testing. The biopsy revealed a type of cancer called adenocarcinoma, while rare, can occur in non-smokers.
For Hubbard, the news was unexpected, but the timing allowed Hubbard to be one of the first 100 patients to benefit from the new robotic procedure that UAB St. Vincent’s East began performing in early 2026.
“Dr. Flanagan was extremely thorough in his approach to my care,” Hubbard said. “I trusted him immediately and knew I was in good hands. I believe in his training and his experience, and frankly I just turned it over to him with complete confidence.”
Traditional bronchoscopy relies on imaging techniques such as fluoroscopy (a special type of X-ray) to guide physicians to suspicious areas. A nodule as small as Hubbard’s would have been very hard to see using this method, and a biopsy wouldn’t be considered until the nodule grew to about 2.5 cm.
“Something this small would not be visible with fluoroscopy,” Dr. Flanagan said of Hubbard’s nodule. “It would have been an absolute no-go.”
Sooner is better
Other options – such as PET scans – can be unreliable when lung nodules are smaller than 1 cm, potentially leaving physicians without clear answers. And waiting for it to grow large enough to biopsy presents other risks. Plus, a traditional biopsy tends to be more invasive and requires several days in the hospital.
With robotic-assisted bronchoscopy, physicians no longer have to weigh the pros and cons of older options in most cases. This advanced technology allows physicians to access smaller nodules that may be hard to reach and biopsy the tissue sooner, allowing for a more timely diagnosis and greater certainty.
“There were no good options to really confirm a diagnosis in a situation like this until we had this technology,” Dr. Flanagan said. “The real advantage here is getting a much more confident answer in this situation where it previously has been difficult.”
Identifying the cancer while it remains a single, small nodule is significant. As cancer grows, treatment options can become more limited. Plus, when cancer is caught early and before it spreads, surgery is usually more successful.
“This could have been something that he potentially wasn’t going to survive if we weren’t able to diagnosis it and act so quickly,” Dr. Flanagan said.
Confidence in his care
For Hubbard, the experience reinforced the trust he had for his care team.
“I never even worried about the mortality involved with this case,” Hubbard said. “Dr. Flanagan has handled this with such confidence, and his bedside manner is so reassuring, I trusted him completely.”
For Dr. Flanagan, Hubbard’s case highlights the importance of advanced diagnostic technology.
“It allows us to have a lot more confidence before we consider surgery,” Dr. Flanagan said. “If the biopsy results show that it’s benign (non-cancerous), it gives us a lot more confidence to say that this is very likely nothing.”
In Hubbard’s case, the procedure gave his care team the information needed to determine what steps to take next. It’s a great example of how advanced technology is helping physicians at UAB St. Vincent’s diagnose disease sooner, more accurately, and with greater confidence.