Lung cancer remains the leading cause of cancer-related mortality worldwide, with early and accurate diagnosis being critical for improving patient outcomes. Traditional tissue biopsy has long been the gold standard for lung cancer diagnosis; however, liquid biopsy has emerged as a promising, minimally invasive alternative. This randomized controlled trial (RCT) aimed to compare the diagnostic accuracy, turnaround time, and clinical utility of liquid biopsy versus tissue biopsy in detecting actionable mutations in lung cancer patients. A total of 200 patients suspected of having lung cancer were randomized into two groups: one undergoing liquid biopsy and the other undergoing standard tissue biopsy. The primary outcome was the concordance rate of genetic alterations detected by both methods, while secondary outcomes included turnaround time, complication rates, and impact on treatment decisions. Results demonstrated that liquid biopsy identified actionable mutations with a high concordance rate (p<0.001) compared to tissue biopsy, with significantly shorter turnaround times (p=0.002) and reduced complication rates (p=0.01). However, tissue biopsy remained superior in detecting certain rare mutations. These findings suggest that liquid biopsy offers a viable, rapid, and less invasive diagnostic tool for lung cancer while maintaining high diagnostic accuracy. Future studies should focus on refining liquid biopsy sensitivity and expanding its clinical applications.