Mesothelioma Biopsy

A mesothelioma biopsy is the only definitive way to diagnose mesothelioma. Doctors perform biopsies to acquire tissue or fluid samples from a patient. These samples undergo testing to determine whether or not mesothelioma is present.


Written by Jenna Campagna, RN


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What Is Involved in a Mesothelioma Biopsy?

A biopsy is a medical procedure involving the extraction of tissue or fluid from the body. Doctors usually perform a mesothelioma biopsy in one of the areas where this cancer originates, which is often either the lining of the lung cavity (pleura) or the lining of the abdominal cavity (peritoneum).

There are two methods for mesothelioma biopsy procedures: surgical biopsies and non-surgical/needle biopsies.

Surgical biopsies involve extracting tissue. Needle biopsies usually involve removing fluid samples. Tissue samples are more dependable than fluid samples for diagnosing mesothelioma.

According to one study published on UpToDate, a fluid biopsy accurately diagnosed 26% of mesothelioma cases.


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By comparison, camera-assisted tissue biopsies correctly diagnosed 98% of the cases utilizing this method.


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What Tests Happen Before a Biopsy?

There are several procedures used in the process of diagnosing mesothelioma. Patients usually begin with imaging tests, such as an X-ray, computed tomography scan or positron emission tomography scan.

Imaging tests provide visual representations of where mesothelioma might exist in your body. While these scans are helpful, biopsies are the only conclusive way to determine the presence of cancerous cells.

Surgical Mesothelioma Biopsies

A surgical biopsy involves extracting bodily tissue. Your body’s tissue is composed of cells, some of which may be diseased. The extracted sample will either confirm or deny the presence of mesothelioma in the area where the tissue came from.

Once the biopsy finishes, the surgeon sends the tissue sample to a pathologist for testing. Mesothelioma pathology is the study of tissue and fluid samples to determine if infected cells are present.

Doctors typically use one of two methods for a surgical biopsy: traditional or camera-assisted. Traditional surgical biopsies involve making a large incision in the area where doctors believe cancer exists. This method is used to remove a few samples of tissue for testing.

Camera-assisted biopsies, also called endoscopic biopsies, involve making a tiny incision and using a tube-like instrument to look inside the body. Doctors can also insert a needle through the small opening to remove a small amount of tissue. They do this using fine-needle aspiration (which involves a thin needle) or core biopsy techniques (which involves a larger needle).

There are different procedures associated with each method. The type of biopsy you’ll undergo depends on where doctors believe your cancer exists based on imaging tests.

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A thoracotomy is a traditional surgical mesothelioma biopsy used to diagnose pleural mesothelioma. This procedure involves opening the chest cavity and removing tissue for testing.

A thoracotomy also allows surgeons a firsthand look at the disease in the chest cavity, pleura and lung cavity. Getting this close-up view also helps doctors with staging pleural mesothelioma and determining if a patient is a surgical candidate.

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A laparotomy is a traditional surgical mesothelioma biopsy used to diagnose peritoneal mesothelioma. This procedure involves opening the stomach and removing tissue for sampling.

A laparotomy also allows surgeons a close-up look at the disease inside the peritoneum and abdominal cavity. This firsthand view of the cancer can help doctors in staging peritoneal mesothelioma and determining if surgery is beneficial.

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A thoracoscopy is a camera-assisted surgical biopsy used to diagnose pleural mesothelioma. It’s a less-invasive alternative to a thoracotomy.

Video-Assisted Thoracoscopic Surgery (VATS) involves a tiny camera attached to a thin tube (thoracoscope) being inserted into the chest cavity. Doctors use the thoracoscope to view the chest cavity for metastasis. They also can use a needle to remove a small tissue sample for testing.

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A laparoscopy is a camera-assisted surgical biopsy used to diagnose peritoneal mesothelioma. It’s a less-invasive alternative to a laparotomy.

The procedure involves a small camera attached to a thin, lighted tube (laparoscope) being inserted through a small incision in the abdomen. Surgeons often use a needle to remove a small tissue for testing. They also use the laparoscope to examine organs, which can determine how far the mesothelioma has spread.

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A mediastinoscopy is a camera-assisted surgical mesothelioma biopsy used for diagnosing and staging pleural mesothelioma. This procedure is an alternative to a thoracotomy and thoracoscopy. It’s used explicitly when doctors believe the mesothelioma tumors have spread to lymph nodes between the lungs.

This procedure involves examining the mediastinum, which is the space between your lungs and behind your breastbone (sternum), for the presence of mesothelioma cells. Doctors insert a thin, lighted tube (mediastinoscope) with a camera attached. Viewing this area helps with staging pleural mesothelioma.

Doctors also often remove tissue samples from the lymph nodes in the area to get a definitive answer of whether mesothelioma has spread to the mediastinum.

Non-Surgical/Fluid Biopsies for Mesothelioma

Non-surgical mesothelioma biopsies involve extracting samples of fluid from near the lungs or abdomen. Doctors use a needle to remove the fluid, which may carry cancerous cells. This fluid sample can provide evidence of mesothelioma in the area where it was taken from.

Once the biopsy concludes, the doctor sends the fluid sample to a pathologist for testing. The study of fluid samples is called “cytology.” This diagnosis method is less invasive than a surgical biopsy, but it’s far less definitive.

Fluid samples have a higher probability of offering inconclusive or misleading data to cytologists. These samples also include fewer cells for studying than tissue samples provide.

There are three types of non-surgical or needle mesothelioma biopsies. They differ in which area of the body is the subject of the biopsy.

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A thoracentesis is a type of needle biopsy used to retrieve fluid samples. This procedure can provide evidence of pleural mesothelioma.

A small incision is made in the chest, and a tube is inserted through the incision. Doctors remove fluid from the pleura or lung cavity and examine it. This procedure is also used as a pain-relief surgery for late-stage pleural mesothelioma.

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A paracentesis is a type of needle biopsy used to obtain a fluid sample from the abdomen. This procedure can provide evidence of peritoneal mesothelioma.

A small incision is made in the abdominal cavity, and a tube is inserted. Doctors remove fluid from the peritoneum or affected area and test it for mesothelioma. This procedure is also used as a pain-relief surgery for advanced peritoneal mesothelioma.

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A pericardiocentesis is a type of needle biopsy used to obtain fluid from near the heart. This procedure is used if doctors believe a patient may have pericardial mesothelioma.

A small needle is inserted into the pericardium, which is the lining around the heart. Doctors remove fluid from the area and examine it for evidence of cancer. A pericardiocentesis can also provide pain relief to patients suffering from severe fluid buildup in the pericardium.

Which Mesothelioma Biopsy Is Right For You?

Not every patient will undergo the same biopsy procedure. The location of the original tumor is one of the most important factors. Another is how much metastasis shows up on imaging scans.

For instance, less-invasive camera-assisted needle biopsies may help for early-stage patients. The disease has not spread far, so doctors won’t need to view the entire thorax or abdomen to digest the scope of the disease. Late-stage patients may need a more-invasive approach to uncover all areas where the disease has spread.

Seeing a specialist is crucial for people who suspect they may have mesothelioma. They can get their tissue or fluid sample examined by a pathologist and improve their chances of an accurate mesothelioma diagnosis.

Misdiagnosis is common with this disease, so we urge you to prioritize experience and expertise when seeking medical care. If you have symptoms and want to take steps toward getting a biopsy, use our free Doctor Match program to get connected with a specialist.

Common Questions About Mesothelioma Biopsies

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What types of biopsies are used for pleural mesothelioma?

The two primary types of mesothelioma biopsies are tissue samples and fluid analysis. The procedures used for pleural mesothelioma, which forms near the lungs, are:

  • Thoracotomy
  • Thoracoscopy
  • Mediastinoscopy
  • Thoracentesis
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Which types of biopsies are used for peritoneal mesothelioma?

Peritoneal mesothelioma, which forms in the lining of the abdominal cavity, is diagnosed by removing either tissue or fluid from the lining. The biopsy procedures a doctor may use are:

  • Laparotomy
  • Laparoscopy
  • Paracentesis
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Which biopsy is best for detecting mesothelioma?

Tissue biopsies are far more reliable than fluid biopsies for detecting mesothelioma. According to one study, fluid biopsies were 26% accurate while camera-assisted tissue biopsies were 98% accurate. The use of cameras attached to thin needles has made tissue biopsies much less invasive than decades ago.

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Where can you get a mesothelioma biopsy?

Most top cancer centers in the United States can perform a mesothelioma biopsy. The first step is detecting symptoms and contacting your primary physician. If imaging tests show evidence of cancer in your mesothelial linings, you should request a biopsy from one of the Mesothelioma Centers of Excellence.

Last Edited: January 20, 2021.

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