Pleural effusion is a manifestation of a variety of pulmonary and non-pulmonary conditions. Medical thoracoscopy (MT) proved to be useful for the diagnosis and management of pleural disease. 1 Certain thoracoscopic findings, such as pleural masses or nodules, are suggestive of malignancy. However,many cases of severe inflammation and early-stage malignant diseases, like mesothelioma, are difficult to differentiate. 2Rapid on-site evaluation (ROSE) is commonly used during bronchoscopy. ROSE of transbronchial needle aspirates (TBNA) reduced the number of biopsies performed without loss in diagnostic yield and lowered the complication rate of bronchoscopy. 3,4