Purpose of Review <p>Non-Specific Pleuritis (NSP) is a common diagnosis following thoracoscopy and encompasses a broad range of aetiologies with heterogeneous outcomes. In this article, we review pathophysiology, associated syndromes, and current best practice in follow-up.</p> Recent Findings <p>NSP typically runs a benign disease course; however, the biomechanical consequences of subsequent tissue re-modelling can be severe. A proportion of patients develop malignancy, notably pleural mesothelioma (PM), and clinicians currently lack the ability to stratify those at risk. Some may be harbouring occult malignancy with false-negative pleural biopsies. Alternatively, NSP may represent a true pre-PM precursor supported by the recent characterisation of mesothelioma-in-situ.</p> Summary <p>Prospective surveillance of NSP patients could unlock the final biological milestone preceding PM evolution. Progress in this area would permit a more personalised patient stratification, whilst offering novel opportunities for translational research. The PREDICT-Meso International Accelerator Network has been established to focus on this goal.</p>