Real-world Comparative Analysis of Transbronchial Versus Transthoracic Biopsy for Middle Lung Zone Pulmonary Lesions in the Preadvanced Bronchoscopy Era

Experienced clinician-driven triage of middle lung zone lesions, based on lesion characteristics, effectively guided initial diagnostic approaches. When appropriately triaged, an initial transbronchial approach resulted in fewer complications, shorter workup duration, and lower costs for pathologic nodal staging, even in an era predating advanced bronchoscopy. Although limited by its retrospective and historical design, these findings provide descriptive insights and underscore the continued value of established diagnostic practices in settings without universal access to newer technologies.