Pleuroscopy First Versus Thoracentesis First in Patients With Suspected Malignant Pleural Effusions

This is a randomized control trial of patients with suspected malignant pleural effusions to compare whether patients who have a thoracentesis or pleuroscopy (pleural biopsy) obtain an adequate biopsy, achieve a diagnosis, and begin cancer-directed therapy faster.

Inclusion Criteria: * Referral for diagnostic pleural procedure. * Age ≥ 18 years. * Suspected malignant pleural effusion (Suggestive radiologic appearance (based on computed tomography or positron emission tomography) OR suspected cancer with associated effusion.) Exclusion Criteria: * Inability to provide informed consent. * Needs emergent drainage. * Pleural effusion is known to be malignant. * Suspected transudative, infectious or inflammatory effusion etiology. * Having prior inconclusive/non-diagnostic thoracentesis or pleuroscopy. * Patient is deemed by the clinical team to be more appropriate for VATS biopsy. * Terminally ill patients in whom a diagnosis will not change management, or who is unlikely to be a candidate for oncological treatment due to significant comorbidities. * Pregnancy