Biopsies are used to acquire cell and tissue samples from a patient. Pathology and cytology tests are then carried out to test the presence of mesothelioma.

The Only Conclusive Diagnosis for Mesothelioma

While there are several other diagnostic procedures, biopsies are the only way doctors can identify cancerous cells. It’s also the only definitive way to determine if a patient has mesothelioma.

3 Methods for Biopsy Procedures

  • Surgical biopsies

    Patients are placed under anesthesia to allow doctors access to affected tissue. Pathology reports determine presence of cancer.

  • Camera-Assisted Surgical Biopsies

    Less invasive than traditional surgical biopsies. Retrieved tissue is examined by means of a pathology report.

  • Nonsurgical biopsies/fine needle aspiration

    Least invasive biopsy. Patients are generally awake for the procedure. Fluid is drawn from the patient and examined for the presence of mesothelioma.

After a mesothelioma biopsy is taken, a specialist will run a histology (study of tissue samples) or cytology (study of cancer cells) report to determine if the patient has mesothelioma. Specialists also diagnose the patient with a cell type (epithelioid, sarcomatoid, biphasic) at this stage. Learn more about biopsy procedures in our free Mesothelioma Guide.

Surgical Biopsies

A surgical biopsy is used to extract a sample of tissue from the affected area. This sample can help determine the presence of mesothelioma in the lungs, abdomen, or heart. Patients are given anesthesia prior to the surgery. A surgeon takes a tissue sample from the patient and the sample is sent off to a pathologist for testing.

  • Thoracotomy

    A thoracotomy is the surgical opening of the chest cavity. It allows surgeons to get a better look at the inside of a patient and look for possible tumors on the lining of the lungs or heart. A thoracotomy is used to gather tissue biopsies for doctors to test for the presence of pleural mesothelioma.

  • Laparotomy

    A laparotomy is abdominal explorative surgery. In mesothelioma patients, it is used to look for the existence of peritoneal mesothelioma. Surgeons can look for tumors on the peritoneum (lining of the abdomen). A tissue sample is tested for cancer.

Camera-Assisted Surgical Biopsies

A camera-assisted surgery is less invasive than surgical biopsies. There are only two to three small incisions made when the doctor begins the biopsy. A camera is used to look at the surrounding area while another tool is used to cut part of the cancerous tumor for testing.

  • Thoracoscopy

    Video-Assisted Thoracoscopic Surgery, VATS, is a minimally invasive surgery used to diagnose mesothelioma. A tiny camera is used to explore the chest cavity. A tissue sample is also taken for analysis. VATS can also be used in removing tumors.

  • Laparoscopy

    A laparoscopy is a procedure done with a small camera attached to a thin tube. The camera is inserted through a small incision in the stomach and used examine organs and determine the extent of metastasis.

  • Mediastinoscopy

    A mediastinoscopy uses a camera to explore front of the lungs. A tissue sample can be taken directly from the lungs and further examined. This tissue can show the existence of infection, inflammation, or mesothelioma.

  • Histology

    Histology is the study of tissue samples gathered from a patient with potential mesothelioma. The histology report allows a doctor to understand more about a patient’s cancer. The doctor is also able to create a successful treatment plan based on the histology report created after a surgical biopsy. Histology reports are more conclusive (96%) than cytology reports (84%).

    After a sample is sent to a lab, it is examined and processed by a pathologist (a doctor who studies diseases). It is divided into small enough sections that it can be examined on a slide under a microscope.

    The sample is then stained. By introducing different stains to the tissue sample, different cells become highlighted. If the sample is positive for cancer, these cells become visible to the person examining it. Staining also shows the cell type (epithelioid, biphasic, and sarcomatoid) of the mesothelioma cells.

Non-Surgical Diagnosis

Non-surgical biopsies gather samples of fluid that may build up around the lungs, abdomen or heart. A needle is used to extract the fluid, which may carry cancerous cells. Sometimes, this fluid can help determine what type of cancer the patient has.

Fine Needle Aspiration

Fine needle aspiration may be used to collect fluid from an affected area. A long, thin needle is inserted into the affected area to collect the sample. This sample can be tested to confirm the presence of malignant cells.

  • Thoracentesis

    A thoracentesis can be used to retrieve fluid samples in patients who may have pleural mesothelioma. A small incision is made, and a tube is inserted into the incision. Fluid that has built up around the lungs is then drained and taken for further examination. It can also be used for pain relief purposes such as draining pleural effusions.


    A paracentesis is used to obtain a fluid sample from the abdominal area. A patient is given local anesthesia and a needle is inserted into the abdomen. The amount of fluid removed depends on the patient. Regardless of the amount, this fluid is tested for peritoneal mesothelioma. This procedure can also provide pain relief in patients with ascites (fluid buildup in the abdomen).


    Patients who are suspected to have pericardial mesothelioma undergo a pericardiocentesis. This procedure involves a needle being inserted into the pericardium (lining of the heart) to collect fluid samples. A pericardiectomy can provide both a fluid sample and pain relief for the patient.


    The cytology of cancer cells can be observed from the fluid sample that is extracted from the above biopsies. Cytology is the examining of cells under a microscope. The cytology can help a physician determine if the patient has malignant mesothelial cells. A cytology report isn’t as reliable as a pathology report. However, cytology reports are easier to obtain, are less painful, and cost less than a pathology report.

Which Biopsy Is Right For You?

When mesothelioma is suspected, the type of biopsy patients undergo depends on imaging tests, blood tests and their doctor. The location of the tumor is also an important factor. Peritoneal mesothelioma patients, for example, tend to undergo fine needle aspiration because parts of the peritoneum may be difficult to reach surgically. Thoracoscopic surgeries are the most common biopsy for pleural patients.

Seeing a specialist is crucial for patients suspected of having mesothelioma. Doctors experienced in recognizing mesothelioma in pathology and cytology reports are a must because misdiagnosis is all too common with this disease. Use our interactive Doctor Map to find a specialist near you.