Mesothelioma Biopsy

Quick Summary

The only way to confirm a mesothelioma diagnosis is through a biopsy. There are many types of potential biopsies which may be prescribed depending on the nature of the patient’s symptoms. Being aware of how biopsies work, the types that may be used, and what to expect can help patients feel more at ease with the process.

Mesothelioma Biopsy Overview

While a doctor will call for many tests, including bloodwork and x–rays, and rely heavily on patient symptoms and medical history, the only definitive way to diagnose mesothelioma is through a biopsy.

But there are numerous different types of biopsies which might be used in a possible mesothelioma case. It is important that a physician perform the most relevant type of biopsy for the patient’s specific case and ensure an accurate diagnosis.

If your doctor has recommended a biopsy, here are the key facts that you should know:

  • A biopsy is simply collecting a sample of your cells from a problem area to determine if cancerous cells are present
  • There are mainly 3 types of biopsies: non-surgical (needle) biopsies, endoscopic biopsies, and open surgery biopsies
  • Either fluid (cytology) or tissue (histology), or both, might be collected in a biopsy, but only tissue will provide a definitive diagnosis

What is a Biopsy?

A biopsy is simply when a physician collects cell and/or tissue samples from the body for analysis. The sample may be drawn from fluid or directly from tissue depending on the specific case and affected area.

Biopsy Update

The collected sample(s) is then sent to a pathologist, a specialist, who will examine it under a microscope.

Tissue Samples

In most situations when checking for mesothelioma, a doctor will try to collect tissue samples directly from the suspected area, usually from the tissue covering the lungs (pleura) or from the abdomen lining (peritoneum) based on other symptoms and information gathered prior to the biopsy.

There are multiple ways to perform these biopsies, which will be discussed in more detail below.

Fluid Samples

If the patient experiences fluid buildup as one of their symptoms, then the doctor may choose to test the fluid for mesothelioma cells. In most cases, the fluid will either be pulled from the chest (thoracentesis), the abdomen (paracentesis), or the fluid sac surrounding the heart (pericardiocentesis).

The procedure will involve local anesthetic to the area of skin where the needle will be inserted. A hollow needle will be inserted into the fluid-filled area to draw out a sample. The procedure can be done at the doctor’s office or in a hospital.

The pathologists will look for specific chemical markers as well as cancer cells. If pathologists fin cells, they can be tested further to determine what type of cancer they are.

However, a drawback to testing fluid samples is that even if the fluid sample is free of cancer cells, it does not mean the patient is cancer-free. It could simply mean that the sample did not contain any cancer cells.

The most reliable method, then, is the tissue sample biopsy, mentioned above and discussed below in further detail. Biopsies allow doctors to get true tissue samples of potential cancerous areas.

What Does a Biopsy Detect?

Once the pathologist receives the sample, he or she will examine the cells to determine what type they are. If provided with a sufficient sample, the pathologist will be able to identify whether or not the cells are cancerous, and if so, what type.

If the cells are mesothelioma cells, he or she will also be able to determine what type of mesothelioma it is based on the appearance of the cells.

As stated above, while other tests will likely precede a biopsy, the biopsy is the only way to definitively diagnose that a patient has mesothelioma and not some other form of cancer or health concern.

Types of Biopsies

As previously mentioned, doctors can perform multiple types of biopsies in the effort to identify mesothelioma.

The factors that determine what type of biopsy to perform include:

  • Location of the tumor and/or where symptoms are occurring
  • The patient’s overall health and well-being
  • The condition of the tumor/tissue influencing what manner of tissue collection would be most suitable

As with most medical procedures, each option has its pros and cons.

Needle Biopsies

A needle biopsy is a less invasive biopsy method. It requires only local anesthetic, requires no incision, and can be done as an outpatient procedure, meaning you will not have to stay overnight in a hospital.

There are a few different types of needle biopsies.  

  • CT-guided core biopsy: the most common and recommended form of needle biopsy is a CT-guided core biopsy. This is where a needle with a special tip meant for cutting tissue is inserted into the lining of the abdomen or lungs. A CT scan is used to help guide the way and a sample of tissue is removed for analysis.Benefits of a CT-guided core biopsy are that it is the least invasive tissue biopsy option and requires little to no downtime.Potential negatives of a CT-guided biopsy, though, are that it can be difficult to get large enough of a sample for a definitive diagnosis.
  • Fluid extraction: the other method of needle biopsy is when a long, hollow needle is inserted into the body to extract a sample of the fluid. As mentioned above, the cells in the fluid are analyzed to determine if they are cancerous, and if so, what type.Again, while being an extremely fast and relatively painless procedure, like the previous, there is a risk that the sample is not sufficient enough to produce a definitive diagnosis.

Surgical Biopsies

The more invasive but more definitive and reliable form of biopsy is a surgical biopsy, or which there are two main categories:

  • Endoscopic biopsies: A procedure requiring general anesthetic and small incisions through which an endoscope (a thin tube with a small camera and light on the end) is inserted. At the end of the scope is a tool used for gather tissue samples.
  • Thoracoscopy: If the area of concern is the lungs and chest, the procedure is called a thoracoscopy and will involve taking a sample of the pleura of the lung. Small incisions are made in the patient’s chest for the thoracoscope to fit through.
  • Laparoscopy: If the area of concern is the abdomen, the procedure is called a laparoscopy. Small incisions are made in the abdomen and the laparoscope is inserted to collect tissue samples.

While endoscopic biopsies are more invasive and therefore do carry more potential risks and longer downtime, there are numerous benefits.

An endoscopic biopsy allows the doctor an opportunity to look around and see what is going on inside. It allows them a chance to see where the cancer is and if it has begun to spread.

It also allows for the opportunity to remove fluid, if there is any, which will both provide physical relief to the patient as well as more samples to analyze.

Finally, endoscopic biopsies guarantee a substantial collection of actual tissue from cancer/tumor. This means a much more definitive diagnosis will be possible.

  • Open surgical biopsies: though not as common, sometimes a physician deems an open surgical biopsy necessary to get a sure diagnosis.This type of biopsy is the most invasive and will require a longer recovery time. It involves a larger incision in either the chest (thoracotomy) or abdomen (laparotomy) and allows the surgeon to remove a large tumor/tissue sample. It also allows for removal of the entire tumor at times, which is an added benefit.

What to Expect During a Biopsy

If your doctor is recommending a biopsy and you are facing the possibility of mesothelioma or related diagnosis, the wait is agonizing enough by itself. There is no need to have lack of understanding add to your anxiety.

Knowing what to expect during a biopsy can help put you a little more at ease.

The procedure and your experience will vary depending on what type of biopsy you have been prescribed.

  • For needle biopsies: Whether it will be a CT-guided core biopsy or a fluid sample biopsy, a local anesthetic will be applied to the area where the needle will be inserted. You may have the procedure performed at your doctor’s office or in the hospital as an outpatient procedure.For a CT-guided core biopsy, you will be required to lie very still for approximately 30 minutes.

Following the biopsy, you’ll need to stay in observation for a couple of hours to ensure there are no complications.

For fluid extraction, the time required is even less.

On rare occasions, bleeding or a collapsed lung can occur, so they will keep you in observation until they are sure you are not dealing with either of those.

After observation, you will be free to go and should feel back to normal.

  • For endoscopic biopsies: Endoscopic biopsies will require that you undergo general anesthesia and will require a full hospital stay.You will have one or more small incisions that will have to be tended afterward and will experience some pain and discomfort during the recovery process. As such, you will usually be prescribed pain medication.It is important during the days following your surgery to notify the doctor if you have any breathing difficulties or begin to feel unwell.
  • For open surgical biopsies: Be prepared for a longer recovery time as well as more intensive after-care.You will be placed under general anesthesia and a large incision will be made to allow the doctor to have more room to see and collect samples from the area, as well as give the doctor the capability to remove the tumor altogether if necessary.

Getting a Second Opinion on Your Biopsy Diagnosis

As you may have realized from reading the above, diagnosing mesothelioma even with a biopsy can be difficult. Depending on the type of biopsy that was taken, the results may not be that reliable.

Numerous biopsies may not provide sufficient results to be truly conclusive. Especially if the biopsy is not performed by a specialist, a biopsy could be less than effective.

With so much at stake, it is highly important that you seek a second opinion on your biopsy results. The best choice you could make for your health moving forward is to find a specialist who can help ensure to pursue the most effective biopsy option for you and get the most accurate results.

If you need assistance finding a specialist in your area, or want help understanding your diagnosis, contact our Patient Advocates or Medical Experts today.

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Sources
  1. Cancer Council Victoria, “Diagnosing Mesothelioma” Retrieved from: https://www.cancervic.org.au/cancer-information/cancer-types/cancer_types/mesothelioma/diagnosing-mesothelioma.html. Access on January 12, 2018.
  2. American Cancer Society, “How Is Malignant Mesothelioma Diagnoses?” Retrieved from:https://www.cancer.org/cancer/malignant-mesothelioma/detection-diagnosis-staging/how-diagnosed.html Accessed on January 12, 2018.
  3. Cancer Research UK, “Thoracoscopy and pleural biopsy” Retrieved from: http://www.cancerresearchuk.org/about-cancer/mesothelioma/getting-diagnosed/tests-diagnose/thoracoscopy Accessed on January 12, 2018.

Last modified: February 3, 2018