# Autofluorescence bronchoscopy findings of pseudoprogression after neoadjuvant chemo-immunotherapy in squamous cell lung cancer: A case report

## TL;DR

A case report shows that autofluorescence bronchoscopy can help distinguish pseudoprogression from residual cancer after immunotherapy in lung cancer.

## Contribution

This case demonstrates how autofluorescence bronchoscopy can identify pseudoprogression in lung cancer following chemo-immunotherapy.

## Key findings

- Autofluorescence attenuation after treatment was linked to pseudoprogression, not residual cancer.
- Histopathology showed immune cell infiltration without cancer cells, confirming pseudoprogression.
- Re-biopsy is recommended before surgery to avoid misdiagnosis in post-immunotherapy cases.

## Abstract

In recent years, multiple clinical trials have demonstrated the efficacy of neoadjuvant chemotherapy (NAC) combined with immune checkpoint inhibitors (ICI) for stage II–III non-small cell lung cancer (NSCLC). Pseudoprogression, a phenomenon in which activated lymphocytes infiltrate tumors and cause transient enlargement, can complicate post-treatment assessment. We report a case of stage III squamous cell carcinoma in the right lower lobe with endobronchial spread treated with NAC plus ICI. Autofluorescence imaging (AFI) bronchoscopy after treatment showed further autofluorescence attenuation despite no residual malignancy, consistent with pseudoprogression. Histopathology revealed infiltration of CD4+, CD8+ lymphocytes, and CD68+ macrophages without cancer cells. This case highlights that autofluorescence attenuation after immunotherapy may reflect pseudoprogression rather than residual tumor, emphasizing the importance of re-biopsy before surgical decision-making.