The diagnosis of of Malignant Pleural Mesothelioma is sometimes obvious in view of a chest CT. However, other pleural cancers can mimic mesothelioma and the diagnosis has to be established by analysing some pleural tissue. In less than 10% of patients, the diagnosis will be made on pleural fluid aspirated through a simple needle. Most patients with this condition now benefit from a VATS pleural biopsy to establish the diagnosis and a VATS talc pleurodesis to prevent the re-accumulation of fluid around the lung. When fluid is absent, an open pleural biopsy is performed by the surgeon under general anaesthetic. When there is a big bulk of tumour, tissue can be obtained through a special biopsy needle under computed tomography (CT) guidance.