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Mesothelioma Biopsy
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A biopsy is the only definitive way to diagnose mesothelioma. During a mesothelioma biopsy, a sample of tissue or fluid is collected to confirm if it’s cancerous. Doctors may recommend biopsies for people with symptoms of mesothelioma or a known history of asbestos exposure.
Written by Dr. Kristopher Bunting | Medically Reviewed By Dr. Loic Lang-Lazdunski | Edited By Walter Pacheco | Last Update: September 27, 2024
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Written by Dr. Kristopher Bunting | Medically Reviewed By Dr. Loic Lang-Lazdunski | Edited By Walter Pacheco | Last Update: September 27, 2024
What Is a Mesothelioma Biopsy?
A mesothelioma biopsy is a medical procedure where your doctor collects a sample of suspected cancer cells for laboratory testing. It’s the most accurate way to confirm the presence of mesothelioma, a cancer often mistaken for common benign illnesses or other types of cancer.
Biopsies can take anywhere from 30 minutes to 3 hours and may require general anesthesia. Your doctor then sends your biopsied cells to a pathologist to look for evidence of cancer. Laboratory tests can help determine if you have mesothelioma. These tests also provide key information about the specific type of cancer cells present, which can help determine the best treatment for you.
Diagnosing mesothelioma requires a combination of biopsies, imaging scans and blood tests. The type of biopsy a patient needs depends on the location of the tumor. There are several types of biopsies, including an endoscopic biopsy, a fine-needle biopsy and a surgical biopsy. Each type of biopsy is tailored to access different parts of the body and provide accurate diagnostic information.
Key Facts About Mesothelioma Biopsies
- A biopsy is necessary for an accurate mesothelioma diagnosis.
- Biopsies can sample tumors and lymph nodes for cancer cells.
- Tissue samples taken with a biopsy can help determine if cancer has spread.
- Pleural mesothelioma requires a biopsy using video-assisted thoracoscopic surgery.
- Peritoneal mesothelioma requires a fine-needle aspiration biopsy.
Endoscopic Mesothelioma Biopsies
Endoscopic biopsies are minimally invasive procedures used to diagnose mesothelioma. These procedures require general anesthesia and typically involve an overnight hospital stay, especially when the chest is involved.
To perform an endoscopic biopsy, your doctor will insert an endoscope — a long, thin, flexible tube with a light and camera — through a small incision. Using an endoscope, your doctor can identify suspected cancer cells and collect a tissue sample for testing.
Back in 2005, I started developing pain in my abdomen. In June, it was decided that I would have a laparoscopic surgery to check my appendix and determine if I had endometriosis. They removed three tumors from the lining of my abdomen to be biopsied. I had been diagnosed with well-differentiated papillary mesothelioma of the peritoneum.
Megan Hoel, peritoneal mesothelioma survivor
Endoscopic biopsies carry risks such as bleeding and infection. Recovery from general anesthesia can take several hours, during which the patient may feel groggy, confused and in pain. A short hospital stay ensures the patient recovers properly before going home.
Post-procedure, the doctor may restrict certain activities and prescribe antibiotics for up to a week. Some patients may have stitches that need removal in 1 to 2 weeks.
Types of Endoscopic Biopsies for Mesothelioma
There are several types of endoscopic biopsies. Doctors often choose these types of biopsies because they can collect large samples of tumors.
During a laparoscopy your surgeon makes an abdominal incision and then inserts an endoscope. The procedure may require other small incisions to insert surgical instruments.
- Laparoscopy: This procedure is for patients with suspected peritoneal mesothelioma. Doctors can examine the abdominal cavity and collect samples of suspicious tissue and fluid in the abdomen (ascites).
- Mediastinoscopy: This procedure can help diagnose pleural mesothelioma as well as determine the stage of mesothelioma.
- Thoracoscopy and Video-Assisted Thoracoscopy: VATS can collect large samples from multiple sites in the chest. The minimal impact on patients and limited hospital stay make VATS an essential tool for diagnosing pleural mesothelioma, especially as an alternative to open surgery.
A surgeon may perform a mediastinoscopy while the patient is under anesthesia for a thoracoscopy. A surgeon inserts an endoscope at the base of the neck to obtain tissue samples of the lymph nodes around the windpipe.
During a thoracoscopy, a surgeon inserts an endoscope between the ribs to remove excess fluid, examine the appearance of the inside of the chest and take tissue samples. VATS is a more involved type of thoracoscopy where a surgeon inserts an endoscope and surgical tools into the chest cavity through small incisions.
Fine-Needle Biopsy for Mesothelioma
A fine-needle biopsy for mesothelioma is a quicker and less invasive procedure than endoscopy. Although it’s not as effective as thoracoscopy for diagnosing pleural mesothelioma, it can be a safer alternative for some patients and is effective for diagnosing peritoneal mesothelioma.
It’s typically performed as an outpatient procedure with local anesthesia. It uses a long, hollow needle attached to a syringe to remove up to 10,000 sample cells for analysis. Your doctor will typically use an ultrasound or CT scan to accurately guide the needle to the target.
Diagram shows how a fine-needle biopsy is collected.
This method carries fewer risks than endoscopy, though patients still face a small risk of infection or bleeding. For lung biopsies, there’s a risk of a collapsed lung and potential bleeding into the space around the lungs (hemothorax). Coughing up a small amount of blood after a lung biopsy is normal.
Fine-Needle Biopsy Procedure
Before deciding on a fine-needle biopsy, you should talk to your doctor about what you can expect. Depending on your individual needs and health conditions, you may need to take medication for pain or anxiety before the procedure.
- Preparation: Your doctor will clean your skin, apply local anesthesia to numb the area, and position you for easy access to the biopsy site.
- Procedure: Using ultrasound or CT scans for guidance, your doctor inserts a needle into the chest or abdominal cavity to extract tissue samples. The entire process usually takes less than 10 minutes.
- Post-Procedure Care: After removing the needle, your doctor will clean and bandage your incision, which won’t require stitches.
- Sample Analysis: Your doctor sends the tissue samples to a pathology lab for analysis, with results typically taking several days to a week or more.
You can go home after the procedure. Experiencing some pain is normal. Depending on the doctor’s instructions, the patient may take over-the-counter pain medications and will need to limit their physical activity for several days.
Thoracentesis and Paracentesis
Thoracentesis and paracentesis are 2 other procedures that aren’t true biopsies, but they’re similar. Thoracentesis drains fluid from around the lungs, and paracentesis drains fluid from the abdomen.
Using local anesthesia, your doctor inserts a long, blunt needle to drain fluid from pleural effusions in the lungs and ascites in the belly. This helps them determine the cause of your excess fluid.
Neither procedure can provide an accurate mesothelioma diagnosis, but they can help in the diagnostic process. Many other conditions cause excess fluid, so it’s important to rule them out. Removing fluid also helps relieve symptoms of pleural effusion or ascites such as shortness of breath and abdominal swelling.
Jim Madaris
Verified Asbestos.com Survivor
Thoracentesis Drains Painful Fluid for Mesothelioma Survivor
Jim Madaris developed pleural effusion after abdominal surgery with HIPEC for peritoneal mesothelioma because the tumor cells migrated into the thoracic cavity. Doctors first used a thoracentesis to drain the fluid. Eventually, he received a pleurodesis to eliminate the space between the lungs and the chest wall.
Surgical Mesothelioma Biopsies
Doctors don’t typically use surgical biopsies to diagnose mesothelioma. However, when an endoscopic or fine-needle biopsy isn’t possible, the patient may require surgery to identify and biopsy tumors.
A surgeon performs a surgical biopsy during open surgery, which allows the doctor to clearly see any tumors and collect large samples — including whole tumors. The type of surgical biopsy a patient needs depends on the location of the suspected mesothelioma.
Types of Surgical Biopsies for Mesothelioma
- Laparotomy: A laparotomy is an exploratory surgery where doctors open the abdomen. This procedure may help diagnose peritoneal mesothelioma.
- Thoracotomy: A thoracotomy involves opening the chest cavity or pleural space around the lungs.
When performing a surgical biopsy, the surgeon will usually remove as much of the suspected cancer as possible. This provides a large sample of cancer cells for diagnosis and analysis. It has the highest accuracy rate for mesothelioma diagnosis, but it also carries the greatest risk of complications.
Surgical biopsies require general anesthesia and large incisions. As with any major surgery, there is a significant risk of bleeding, infection or other complications. Surgical biopsies also require much more recovery time than less-invasive biopsies.
The experience of the pathologist reviewing the biopsies is very important. It’s important that the biopsies get reviewed by a hospital or a medical center that has a pathologist who specializes in mesothelioma and examines a lot of samples.
How You Can Prepare for a Mesothelioma Biopsy
Preparation for a mesothelioma biopsy varies depending on the type, but your doctor will provide detailed instructions. It can help to give permission for your healthcare team to talk to a loved one, typically the person who brings you to and from your procedure, as anesthesia following your biopsy may affect your memory.
Tips to Prepare for a Biopsy
- Follow Pre-Procedure Instructions: Leave valuables at home, remove jewelry and wear comfortable clothing. Follow any specific instructions about fasting before your procedure.
- Medication Management: Tell your doctor about all medications you’re taking, including over-the-counter drugs, herbal supplements and vitamins. If you’re on blood thinners (e.g., coumadin, heparin or aspirin), your doctor may advise you to stop taking them temporarily to reduce the risk of bleeding.
- Day of Your Procedure: If receiving general anesthesia, arrange for someone to take you to and from your procedure. Without a companion, the procedure may not be performed. If you plan to stay overnight, bring a bag with essentials like a change of clothes and a cell phone charger.
- Aftercare and Results: Ask questions about what you need to do after your procedure and when to expect the biopsy results.
One of the most important steps in preparing for a procedure is asking questions — and getting answers. Ensure a mesothelioma specialist reviews your biopsy results to get an accurate diagnosis.
Understanding Your Biopsy Results and Next Steps
After your biopsy, you and your doctor will receive a pathology report with your biopsy results. Mesothelioma biopsy findings can include the subtype of mesothelioma, the size of the tumor(s), whether the mesothelioma has spread and other information. Doctors use this information, along with blood tests and imaging studies, to determine the mesothelioma stage and select the most effective treatment.
You will need to discuss with your doctor what the results mean and what options you have for treatment. Both your doctor and the pathologist should have experience with mesothelioma to interpret the results properly. Communicating well with your doctor is important. You and your loved ones can prepare questions and communication strategies for speaking with doctors about biopsy results and the next steps.
Coping with a mesothelioma diagnosis is a challenge, but it is one you do not have to face alone. The Mesothelioma Center is here to provide the information and support mesothelioma survivors need.
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