There are many different types of biopsies used to diagnose mesothelioma. Which type of biopsy is used depends on results from imaging tests and the doctor’s physical examination of the patient.
Noninvasive: Doctors take a fluid sample from the part of the body affected by mesothelioma. Noninvasive biopsies are convenient, but fluid samples aren’t as reliable as tissue samples.
Minimally invasive: Doctors use cameras during minimally invasive biopsies. The cameras allow the doctor to see inside the body to find an acceptable tissue sample.
Surgical: During a surgical biopsy, doctors make a large incision that allows them to see directly inside the patient. This is the surest way to obtain an accurate biopsy.
A biopsy is the only way to confirm a mesothelioma diagnosis and determine which type of mesothelioma a patient has.
Specialists perform noninvasive biopsies using a needle. The needle is inserted into the area affected by mesothelioma. A doctor draws out fluid or a small tissue sample for testing. Noninvasive biopsies do not typically require anesthesia. The tissue or fluid sample obtained from a noninvasive biopsy is sent to the lab for further testing.
Cytopathology, often called cytology, is how specialists confirm a mesothelioma diagnosis from a fluid sample. The fluid sample taken via noninvasive biopsy is typically placed on a slide and examined under a microscope.
The methods to remove fluid in noninvasive biopsies are also used as palliative treatments. Removing fluid can relieve the pain and discomfort caused by the buildup of fluid around the affected organ(s).
Thoracentesis: A thoracentesis is used for patients with pleural mesothelioma. During this procedure, a small, hollow needle is inserted into the pleural cavity. Fluid drained from the pleura is then examined for the presence of mesothelioma cells. The thoracentesis is also used to alleviate pressure caused by pleural effusion, the buildup of fluid between the lining of the lungs.
Paracentesis: Similar to a thoracentesis, a paracentesis involves the use of a needle to draw fluid from the abdominal cavity. The fluid is examined under a microscope to determine if the patient has peritoneal mesothelioma. A thoracentesis is also used to ease pressure caused the buildup of fluid in the abdominal cavity (ascites).
Pericardiocentesis: The pericardiocentesis is used to obtain a fluid sample from the pericardium, the lining of the heart. During the procedure, a hollow needle is inserted into the pericardium in order to draw out fluid for testing. Fluid taken from the pericardium is examined to determine if a patient has pericardial mesothelioma. Like most noninvasive biopsies for mesothelioma, a pericardiocentesis can also be used as a palliative treatment.
Minimally Invasive Biopsies
Minimally invasive biopsies are performed with the help of a small camera, generally called an endoscope. Using a camera allows the surgeon to see inside of the patient without having to perform a major surgical incision. This helps reduce the patient’s recovery time. The camera guides the surgeon’s tools and helps in obtaining a tissue sample from the tumor.
The tissue sample collected from the mesothelioma is sent to a lab, where it is tested by pathologists.
Video-assisted Thoracoscopy: During a video-assisted thoracoscopic surgery (VATS), the surgeon makes three “keyhole” incisions through which the camera and surgical tools are inserted. The camera helps the surgeon explore the chest cavity and obtain a tissue sample for testing. VATS has also been developed as a surgery to remove mesothelioma tumors.
Mediastinoscopy: During a mediastinoscopy, the surgeon makes a small surgical cut in the neck or chest. A small tube with an attached light and camera lens (mediastinoscope) is then inserted into the front-middle area of the chest cavity (mediastinum). The surgeon takes a sample from any diseased tissue or lymph nodes in the mediastinum and sends it to the lab for further testing.
A mediastinoscopy is beneficial because it allows pathologist’s test samples taken from lymph nodes, which helps them determine how far the mesothelioma has spread.
Laparoscopy: A laparoscopy is used to collect tissue samples from a patient’s abdominal area. The surgeon begins the procedure by making a small incision in the abdomen, usually just below the bellybutton. A small camera attached to a thin tube (a laparoscope) is inserted through the small incision. The laparoscope allows the surgeon to locate tumors from which tissue samples can be taken for testing.
Surgical biopsies allow specialists to collect tissue samples from visible tumors in the chest or abdominal cavity. Unlike minimally invasive biopsies, surgical biopsies require a large incision. Like most major surgeries, surgical biopsies are performed under general anesthesia.
Thoracotomy: A thoracotomy involves opening the chest cavity with a surgical incision. This procedure allows the surgeon to have open access to the chest cavity. Open access makes it easier to identify and remove tissue samples.
Laparotomy: A laparotomy is the surgical opening of a patient’s abdominal cavity. Surgeons use a laparotomy to examine the abdominal organs for any sign of mesothelioma. Once a suspected mesothelioma tumor is located, a sample is taken and sent to the lab for confirmation.
The Right Biopsy
A biopsy is the only method that can confirm a mesothelioma diagnosis. Which biopsy type is used depends on the location of the suspected mesothelioma tumor obtained via imaging tests. A mesothelioma specialist will determine which biopsy type yields the most accurate results.
Only a qualified specialist can accurately diagnose a patient with mesothelioma and get them the best treatment.