# High‐Definition and Autofluorescence Bronchoscopic Imaging for Evaluating Epithelial Changes in Squamous Cell Lung Cancer After Neoadjuvant Immunochemotherapy: A Case Report

## TL;DR

A case report shows how high-definition and autofluorescence bronchoscopy can detect subtle epithelial changes in lung cancer after treatment.

## Contribution

Demonstrates the utility of autofluorescence imaging in detecting residual tissue changes post-immunochemotherapy in lung cancer.

## Key findings

- Autofluorescence imaging revealed a magenta-colored area at the lesion site after treatment, suggesting residual tissue changes.
- The magenta coloration faded over time, indicating possible normalization of epithelial thickening.
- AFI provided insights into tumor progression in obstructed bronchi, aiding surgical planning.

## Abstract

In recent years, perioperative immune checkpoint inhibitors have become indicated for early‐stage lung cancer, emphasizing the importance of high‐resolution endoscopic evaluation of preoperative drug therapy. At the initial evaluation, a male patient in his 60s presented with a primary lesion obstructing the right upper lobe bronchus. After three courses of neoadjuvant immunochemotherapy, chest computed tomography and endoscopic examinations showed a near‐complete response. Narrow‐band imaging indicated that subepithelial vascular regularity and distribution patterns were within normal limits. However, autofluorescence imaging (AFI) revealed a magenta‐colored area on the bronchial epithelium corresponding to the initial lesion site. Two months later, the magenta coloration faded, suggesting pathological normalization of the bronchial epithelium thickening. AFI enabled visualization of tumor progression in the bronchi otherwise completely obstructed by the lesion, potentially offering valuable information to determine bronchial resection lines during surgery.

This is a case report of a patient with stage IIB squamous cell carcinoma (SCC) who underwent neoadjuvant chemoimmunotherapy. Bronchoscopic examination following treatment revealed a complete response (CR) in terms of macroscopic appearance. However, autofluorescence imaging (AFI) still showed a magenta hue at the lesion site, suggestive of residual or altered tissue characteristics. A pathological evaluation was subsequently performed to assess the correspondence between endoscopic imaging and histological findings.