Wijmans L, et al. - Researchers examined the value of pleural confocal laser endomicroscopy (CLE) imaging for biopsy guidance to differentiate malignant from benign pleural disease. Patients with (suspected) malignant pleural mesothelioma (MPM) based on PET-CT imaging scheduled for pleural biopsies were included in this prospective, multicenter study. Success was achieved in obtaining CLE imaging in 19 of 20 diagnostic pleural biopsy procedures (thoracoscopy: n=4, surgical excision: n=3, CT scan: n=3, ultrasound: n=9, esophageal ultrasound guided: n=1) in 15 patients. Regardless of the biopsy method, the feasibility and safety of CLE imaging was supported. Real-time visualization of pleural abnormalities in epithelial and sarcomatoid MPM could be distinguished from pleural fibrosis, which suggests the possible utility of CLE as a tool to guide biopsy and lower the present considerable rate of repeat biopsies by identification of areas with malignant cells in vivo (smart needle).