Autofluorescence and white light bronchoscopy for the detection of tumor margins of non-small cell lung cancer after neoadjuvant immunotherapy: a retrospective observational study.

Background: Autofluorescence bronchoscopy (AFB) is commonly utilized for the identification of abnormal tissues for early lung cancer detection. Some studies show that AFB improves the detection of precancerous lesions and cancer. However, its value for patients after neoadjuvant immunotherapy is unknown. This study investigates AFB for assessing tumor margins in such patients. Methods: Between July 2022 and June 2024, our study retrospectively included 22 lung cancer patients (stage IB-IIIC) who received neoadjuvant immunotherapy at the Second Affiliated Hospital of Zhejiang University School of Medicine. Biopsy sites were categorized as either primary central lesions or mucosal infiltrative lesions, guided by AFB manifestations. The results of AFB and pathological biopsies from these patients were collected. Results: All 22 patients were males with non-small cell lung cancer (NSCLC), aged 64.8 years on average. AFB showed pink lesions in all 22 patients. However, pathological biopsies of lesions identified by AFB as positive revealed no neoplastic tissue, showing bronchial mucosa, extruded cells (lymphocytes), and chronic inflammation of the mucosa instead. The concordance rate was 0%. Among 13 patients who underwent surgery, postoperative pathological results indicated that 4 achieved major pathologic response (MPR) and 5 achieved pathologic complete response (pCR), while the remaining 4 patients exhibited viable tumors of 10% or greater. Conclusions: In NSCLC patients after neoadjuvant immunotherapy, positive AFB results are poorly consistent with pathological biopsy, which poses a challenge to its application in evaluating tumor margins prior to surgery.