Autofluorescence bronchoscopy findings of pseudoprogression after neoadjuvant chemo-immunotherapy in squamous cell...

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.