Establishing a diagnosis of mesothelioma is difficult. At this point serum tumor markers have no role in the diagnosis or screening of mesothelioma. Having a high degree of suspicion due to history will help.
Chest CT is important to detect invasion of the chest wall, ribs and mediastinal structures.
Video-assisted thorascopic biopsy is the preferred method. Thoracentesis or closed pleural biopsy may help but may not provide enough tissue to differentiate between mesothelioma and adenocarcinoma.
Bronchoscopy and mediastinoscopy will also help in establishing the diagnosis.