a: VAT is not only the gold standard for securing biopsy tissue for the pathological diagnosis, but it also allows effective drainage of pleural effusion and talc pleurodesis.

b: It is recommended that—unless loculation of the fluid or other physical constraints prevent adequate sampling of the effusion fluid—a minimum of 100 mL of effusion fluid and preferably the entire volume of fluid is submitted for cytology (after sampling of small volumes for biochemical and microbiological assessment). Such sampling is advocated to allow recovery of sufficient numbers of cells for cell block sections and immunohistochemical studies.

c: The anatomical site and extent of lesions should be determined.

d: When tissue invasion cannot be identified, the lesion should be designated as an atypical mesothelial proliferation.