Surgical Biopsy

Quick Summary

If you have been seeing your doctor for mesothelioma symptoms, you have likely undergone numerous tests and provided a thorough medical history. However, the only true way that your doctor will be able to accurately diagnose mesothelioma is through a biopsy—a sample of cell and tissue collected from the affected area of your body. Depending on your specific symptoms, your doctor may suggest pursuing a surgical biopsy rather than the less invasive needle biopsy.

Surgical Biopsy Explained

A surgical biopsy is when a surgeon makes one or more incisions in the patient’s body to gain access to the cancerous areas to collect cell and tissue samples. These samples are sent to a pathologist (a specialist with the skill to examine body tissue and fluid to identify disease).

Types of Surgical Biopsies

There are two main types of surgical biopsies—endoscopic biopsies and open surgery biopsies. Both types do require the patient be under with general anesthesia. Due to the nature of the incisions and invasiveness of the operation, patients should expect a longer recovery time.

Endoscopic Biopsies

Endoscopic biopsies are more common, as they’re the less invasive of the two and provide most (though not all) of the advantages of open surgery. An endoscopy is when a surgeon uses an endoscope—a small tube with a camera and light on the end and a tool attached for collecting tissue samples.

The tools are small and can thus easily fit through minute incisions which are easier on the patient than a large incision across the body. Because the Endoscope includes a camera, the endoscopic biopsies also give the doctor an opportunity to “look around” to see evidence cancer spreading to other parts of the body.

Before the surgery begins, an anesthetist will put the patient to sleep under general anesthesia. Then the doctor will then perform either a thoracoscopy, laparoscopy or mediastinoscopy depending on the location of the cancer.


A thoracoscopy is an endoscopy of the chest and pleural space (outer layer of the lungs). Doctors perform this procedure when they suspect pleural mesothelioma.The doctor will make one or more small incisions in the patient’s chest between ribs and insert the scope.

If there is cancer, the doctor will be able to see it and take a tissue sample with the tool on the end of the scope. If there is any fluid build-up, the doctor will be able to drain the fluid at this time as well, helping alleviate the patient’s discomfort.


A laparoscopy is an endoscopy of the abdominal space. Doctors perform a laparoscopy when they suspect peritoneal (abdominal lining) mesothelioma. During a laparoscopy, the surgeon will make one or more small incisions in the stomach. Gas will then be used to inflate the abdomen to give a better view of the patient’s abdominal organs. The laparoscope will be inserted through a different incision.

As with a thoracoscopy, the doctor will be able to visually see any cancer and take a tissue sample. After removing the tissue, he or she will remove the scope and release the gas from the patient’s abdomen.


A mediastinoscopy is an endoscopy of the pericardium (the lining of the heart). Doctors perform mediastinoscopy when they suspect pericardial mesothelioma, the rarest form of mesothelioma.

A mediastinoscopy is a little more intense on a patient. Doctors will place an endotracheal tube through the patient’s nose or mouth to aid with their breathing. Then, they will make an incision just below the neck through which they will insert the mediastinoscopy. If the surgeon sees a tumor or an abnormal lymph node, they will remove a tissue sample to send to the pathologist.

Open Surgery Biopsies

If a physician fears that they only way to get to a tumor to collect a sufficient sample is through surgery, or if other methods have been inconclusive, then they may prescribe an open surgical biopsy. Though rare, an open surgical biopsy is the surest way of getting the most accurate biopsy results. Such a surgery is far more invasive. They will require a patient to undergo general anesthesia and a longer stay in the hospital after the procedure.

As with endoscopic biopsies, the location of the surgery determines the technical name of the surgery.


During a thoracotomy, a doctor cuts a 3-4-inch incision into the patient’s chest wall to collect the biopsy. A thoracotomy is performed if either pleural (lung) or pericardial (heart) mesothelioma is suspected.

By looking through the incision, the surgeon will be able to evaluate the lungs, heart, and surrounding area to see if and where the mesothelioma has spread. If cancer is found, the surgeon can take a substantial sample of tissue, sometimes removing the entire tumor.


During a laparotomy, the doctor cuts a large incision in the patient’s stomach to examine organs, identify a source for fluid buildup and retrieve a biopsy. A laparotomy is performed if peritoneal mesothelioma is suspected.

As with a thoracotomy, the doctor will be able to view the organs through the incision to determine if cancer is present and whether it has spread, as well as be able to collect a substantial tissue sample and drain fluid. If the surgeon retrieves a tissue sample, it will be sent to a pathologist. In some instances, the surgeon may decide to remove the entire tumor, which will prevent the need for further surgeries down the road.

Most doctors will try less invasive biopsy options before suggesting an open surgical biopsy. But if the tumor is in a location that is hard to reach with a needle or endoscopy, or if previous biopsies were inconclusive, an open surgical biopsy may become necessary.

What do Surgical Biopsies Detect?

Whether an endoscopic or open surgical biopsy, the goal is the same—the collection of a substantial tissue sample for analysis. Once they collect the tissue, your surgeon will send it off to the pathologist for a report.

The pathologist will conduct a histology test (a tissue sample that is viewed under the microscope with the aid of special dyes). He or she will examine the sample to determine whether cancer cells are present and, and if so, what type of cancer they are. If the cancer cells prove to be mesothelioma cells, the specialist will also be able to determine what type of mesothelioma and what stage the disease is in.

Benefits of a Surgical Biopsy

There are numerous benefits to getting a surgical biopsy:

  • The doctor gains a visual of the cancer and the patient’s organs, making it easier to determine whether the cancer is spreading or not
  • The quality of the tissue sample gathered from a surgical biopsy is significantly better than other forms of biopsies and produces much more certain diagnoses
  • If the surgeon deems it necessary during an open surgical biopsy, he or she can perform an emergency procedure and remove the tumor altogether
  • Open surgery biopsies still provide the opportunity to drain any and all fluid

Risks Associated with Surgical Biopsies

While surgical biopsies are more invasive procedures, their risks are still low. Endoscopic biopsies have almost no risks associated with them, as the incisions and tools are so small and the operation is quick.

However, there is still the chance of a bad reaction to the anesthesia, which is present during any surgery. There is also the chance that the incisions could get infected if not cared for properly, and very rare risk of bleeding, organ injury or organ failure (in the most extreme, unlikely case).

Risks for open surgical biopsies are similar. The biggest risk is that of a negative reaction to the anesthesia, including headache, nausea, vomiting, etc. There is also the risk of infection, injury to blood vessels or organs, excessive bleeding, pain and fluid buildup.

Recovery time for both will be longer than non-surgical biopsy options, but the open surgery biopsy will require the longest recovery time by far. The speed of the recovery will depend on, at least in part, the health of the patient.

Seeking a Second Opinion

Diagnosing mesothelioma can be incredibly difficult. Numerous cancers, including lung cancer, can exhibit the same symptoms that mesothelioma does. You need a definitive, accurate diagnosis to ensure that you get the proper treatment and can gain every precious moment back that you can.

While surgical biopsies have a much higher accuracy rate, if you have not pursued a second opinion about your diagnosis, you need to. If you need help finding a mesothelioma specialist in your area, or if you would like assistance understanding your recent diagnosis, please contact our Patient Advocates today.

View Author and Sources

  1. American Cancer Society, “How Is Malignant Mesothelioma Diagnosed?” Retrieved from: alrig Accessed on January 19, 2018.
  2. Cancer Council Victoria, “Diagnosing Mesothelioma” Retrieved from: Access on January 18, 2018.
  3. Cancer Research UK, “Thoracoscopy and pleural biopsy” Retrieved from: Accessed on January 19, 2018.

Last modified: May 7, 2018