Background: Pleuroscopy is a valuable minimally invasive procedure for evaluating undiagnosed pleural effusion. Rapid diagnosis of malignancy is often needed to reduce procedure time and patient discomfort, particßularly when pleurodesis is planned. Imprint cytology is a quick and simple method, though underutilized in pleuroscopy practice in Indonesia. This study aims to compare the diagnostic yield of imprint cytology and histopathology in pleural effusion cases undergoing pleuroscopy. Methods: This observational cross-sectional study was conducted in September–October 2024, involving patients with pleural effusion who underwent diagnostic pleuroscopy. Pleural biopsies were taken using forceps. Imprint cytology was performed by directly smearing the biopsy tissue onto slides, followed by staining. Histopathology was done using standard tissue processing. Results: Of the 25 patients who underwent pleuroscopy during September–October 2024, 14 met the inclusion criteria. Pleuroscopic findings varied, with the most common being lump of mass (35.7%), followed by multiple nodules (21.4%) and sago nodules (14.3%). Histopathology revealed malignancy in 10 patients (71.4%) and nonspecific inflammation in 4 (28.6%). Imprint cytology detected malignancy in 12 patients (85.7%) and infection in 2 (14.3%). Conclusion: Imprint cytology offers a rapid, reliable alternative to frozen section analysis during pleuroscopy, especially in resource-limited settings. It may increase diagnostic sensitivity for malignancy and facilitate timely clinical decision-making.