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Background and Objective: Pleural fluid cytology (PFC) and closed pleural biopsy (CPB) are the two most commonly employed diagnostic tests for malignant pleural effusions. The aim of this study was to determine the benefit and safety of the fiberoptic pleuroscopy and brushing for the diagnosis of unknown pleural effusion.Patients and methods: Twenty patients with suspected malignant pleural effusion and negative cytology for malignancy underwent pleuroscopy with brushing using a 32 Fr chest tube and a flexible fiberoptic bronchoscope for the diagnosis, inspection, and management of patients. All the samples were sent for bacteriological and cytolopathological studies. Patients had a mean followup period of 4.37 ± 1.86 months.Results: Sixteen cases were finally documented to have malignancy, (12 men and 4 women) aged 62.8 ± 5.8 years, while pleuroscopic biopsy provided diagnosis in 12 (75%) of 16 cases. Pleural brushing was diagnostic in 10 (62.5%) of 16 cases. in 2 of these 10 cases, pleuroscopic biopsy was negative. When all procedures were used in combination, the yield increased to 87.5%. When pleural brushing (PBR) was used in addition to pleural biopsy by fiberoptic bronchoscopy, the yield of the diagnosis increased more than 10%. No major complications were encountered with this method. There was no mortality due to these interventions.Conclusion: Fiberoptic pleuroscopy and brushing utilizing fiberoptic bronchoscopy through a chest tube is a relatively safe, simple and well-tolerated technique with a high diagnostic yield for patients with malignant pleural effusion.