Diagnosis of Synchronous Primary Lung Cancers Using EBUS-TBNA and BDBD-Assisted Transbronchial Biopsy During a Single Bronchoscopic Procedure: A Case Report.

Histopathological confirmation is essential to determine the optimal treatment strategy for patients with multiple pulmonary lesions. We report a case of synchronous small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) diagnosed during the same bronchoscopic session using endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and balloon dilation for bronchoscope delivery (BDBD) technique. A 70-year-old man with a history of gastric cancer presented with mediastinal lymphadenopathy and a nodule in the right upper lobe. EBUS-TBNA confirmed SCLC in the mediastinal lymph nodes. For the peripheral pulmonary lesion, BDBD enabled further advancement of the thin bronchoscope, allowing direct visualization and biopsy with standard forceps, which confirmed NSCLC. No procedure-related complications occurred. This case suggests that combining EBUS-TBNA with BDBD facilitates the accurate diagnosis of multiple pulmonary lesions during the same bronchoscopic session.