Lung cancer revisited – CT scan and bronchoscopy concordance after treatment

Introduction: Chest CT-scan and bronchoscopy may give different results in tumor response assessment and permit further therapeutic improvement. Objective: Bronchoscopic evaluation of local response after medical treatment in patients with lung cancer (LC) and endobronchial involvement as compared to CT-scan response evaluation. Methods: This retrospective study included LC patients diagnosed by bronchial biopsy and submitted to bronchoscopic reevaluation after treatment. All patients with bronchial biopsy at reevaluation between 2000-2015 were included. Results: 68 patients with a male predominance (80%) and a mean age of 61 years were included. 73% corresponded to non small-cell lung cancer (73%).A tumor mass (44%), mucosal infiltration (30%) and neovascularization (12%) were the most frequent signs of neoplasia observed at the initial bronchoscopy. 44% were submitted to chemotherapy, 27% to chemoradiotherapy, 8% to radiotherapy and 4% to tyrosine kinase inhibitor. After initial treatment, clinical and imaging evaluation revealed partial response in 54%, stabilized disease in 20%, complete response in 14% and disease progression in 8%.At the time of endobronchial reevaluation, 50% presented CT features of disease progression and in 29% there was no endobronchial evidence of disease progression.Direct signs of neoplasia evolved to a cicatricial or inflammatory aspect in 68% of those who responded to treatment.Agreement between CT-scan and bronchoscopic response was found in 58% of patients.In 33% bronchoscopy allowed for a change in treatment strategy. Conclusion: Bronchoscopy allows for a dynamic lung cancer tissue response evaluation and might have an impact in further therapeutic decisions.