Written By: David Statman
Mesothelioma Biopsy
A biopsy is the only definitive way to diagnose mesothelioma. During this procedure, doctors collect tissue or fluid samples that are examined under a microscope to determine whether mesothelioma cells are present.
Medically Reviewed By
Dr. Stephen Williams
Precision Oncology Scientist
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Medically Reviewed By
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Important Facts About Mesothelioma Biopsies
- There are two main types of biopsies used in the diagnosis of mesothelioma: tissue biopsies and fluid biopsies.
- Tissue biopsies are often more reliable than fluid biopsies for accurately diagnosing mesothelioma.
- Advances in minimally invasive surgery now allow physicians to obtain tissue samples through small incisions using camera-assisted tools, rather than large surgical openings.
- The type of biopsy performed depends on where abnormalities are found. Most patients undergo biopsies of the chest (pleural mesothelioma) or abdomen (peritoneal mesothelioma).
What Is Involved in a Mesothelioma Biopsy?
A biopsy involves removing a small sample of tissue or fluid from the area where mesothelioma is suspected. Mesothelioma develops in the lining of the lungs (pleura) or the lining of the abdomen (peritoneum), with rare incidences of forming in the lining of the heart or testes.
There are two primary biopsy approaches:
- Surgical biopsies, which remove larger tissue samples
- Needle (non-surgical) biopsies, which collect fluid or smaller tissue samples
Because mesothelioma can closely resemble other diseases, tissue samples provide the most dependable results.
According to one study published on UpToDate, a fluid biopsy accurately diagnosed 26% of mesothelioma cases.
26%
By comparison, camera-assisted tissue biopsies correctly diagnosed 98% of cases.
98%
What Tests Happen Before a Biopsy?
Before a biopsy is performed, patients typically undergo imaging studies, such as:
- Chest X-ray
- CT (computed tomography) scan
- PET (positron emission tomography) scan
These imaging tests help identify suspicious areas and guide biopsy planning. However, imaging alone cannot confirm mesothelioma; only a biopsy can definitively diagnose the disease.
Surgical Mesothelioma Biopsies
A surgical biopsy involves removing a sample of bodily tissue, which is then examined for abnormal cells by a pathologist. Body tissues are made up of cells, and when cells mutate and begin to multiply rapidly, this is often an indication of cancer.
Analyzing these cells allows doctors to determine whether disease is present and if it is benign or malignant. If the tissue contains mutated and an abnormal amount of mesothelial cells – meaning they are multiplying faster than usual – this provides evidence of mesothelioma.
After the biopsy is completed, the surgeon sends the tissue sample to a pathologist for analysis. This process, known as mesothelioma pathology, involves examining tissue (and sometimes fluid) samples under a microscope to identify cancerous changes and confirm a diagnosis.
Types of Surgical Mesothelioma Biopsies
Doctors generally use one of these surgical approaches: traditional (open) biopsies, ultrasound guided biopsies, or endoscopic biopsies.
Traditional surgical biopsies require a larger incision near the suspected cancer site. This approach allows surgeons to collect multiple or larger tissue samples, which may be necessary when extensive disease is suspected or when previous tests were inconclusive.
Ultrasound-guided biopsies are minimally invasive procedures that help doctors obtain small tissue samples. This approach uses real-time ultrasound imaging to guide the needle to the exact area of concern so a tissue or fluid sample can be safely and accurately removed. Doctors may use a very thin needle to extract a small amount of tissue cells or a larger needle to obtain a larger collection of tissue, also known as a core biopsy.
Endoscopic biopsies use minimally invasive tools to obtain tissue samples. Surgeons make a small incision allowing them to insert a thin, tube-like instrument equipped with a camera to give the doctors a clear view of the area of concern. Specialized instruments are then passed through the scope to collect tissue biopsies.
These minimally invasive methods reduce recovery time while still providing highly accurate diagnostic results.
Thoracotomy
A thoracotomy is a traditional surgical procedure used to diagnose pleural mesothelioma. During this procedure, surgeons open the chest cavity to directly remove tissue samples for pathology testing.
This approach allows surgeons to visually examine the disease firsthand within the chest. By viewing the pleura where mesothelioma tumors originate, and surrounding structures, doctors can better assess the extent of the disease.
Because of this direct access, a thoracotomy is especially valuable for accurate staging and for determining whether a patient may be a candidate for surgical treatment. This option is an open surgical procedure, often with more risks and an extended recovery.
Laparotomy
A laparotomy is a traditional surgical procedure used to diagnose peritoneal mesothelioma. During this procedure, surgeons open the abdominal cavity to remove tissue samples for diagnostic testing.
This approach provides surgeons with a direct, close-up view of the peritoneum, where peritoneal mesothelioma develops, as well as surrounding abdominal structures. By observing the extent of disease spread, doctors can more accurately stage the cancer and determine whether surgical treatment may be beneficial.
Thoracoscopy
A thoracoscopy is a camera-assisted surgical procedure used to diagnose pleural mesothelioma. It’s less invasive than a thoracotomy but it still requires general anesthesia and is not without risks.
Video-Assisted Thoracoscopic Surgery (VATS) uses a tiny camera attached to a thin tube (thoracoscope). Doctors use the thoracoscope to view the chest cavity for tumors, diseased tissue, and the extent of disease. They also can use instruments to obtain tissue for testing.
In a recent study conducted in Italy, VATS was especially effective at helping doctors diagnose pleural mesothelioma. The method was 93% accurate in identifying when a patient has mesothelioma and 100% accurate in flagging that a patient does not have mesothelioma.
Laparoscopy
A laparoscopy is a camera-assisted surgical procedure used to diagnose peritoneal mesothelioma. It is less invasive than a laparotomy, using smaller incisions, less pain and shorter recovery time.
The procedure uses a small camera attached to a thin, lighted tube (laparoscope). Doctors insert the camera through a small incision in the abdomen. The lighted camera gives surgeons a clear view of the inside of the abdominal cavity and organs. Instruments can be inserted through the laparoscope to obtain tissue samples for pathology evaluation.
Mediastinoscopy
Mediastinoscopy is a surgical procedure that uses a lighted camera and instruments to obtain samples of tissue or lymph nodes located in the mediastinum (the space between the lungs, behind the sternum). This procedure is beneficial when pleural mesothelioma is suspected to have spread to mediastinal lymph nodes.
The tissue and lymph nodes can provide definitive pathologic confirmation and can help determine the cancer’s stage. Treatment options can often be determined because proven nodal disease can determine the best medical management of mesothelioma.
In current practice, minimally invasive needle-based approaches such as endobronchial ultrasound-guided (EBUS) or endoscopic ultrasound-guided (EUS) biopsy are often used first for mediastinal staging, with mediastinoscopy reserved when additional confirmation is needed or when less invasive sampling is not feasible or is non-diagnostic.
Fluid Biopsies for Mesothelioma
Non-surgical biopsies for mesothelioma involve removing fluid from the pleural or peritoneal space using a needle, typically referred to as thoracentesis or paracentesis. These fluids may contain malignant cells shed from tumors and can offer initial evidence of disease.
After collection, the fluid is sent for cytologic evaluation, where a pathologist examines the cells for features consistent with mesothelioma. While this approach is minimally invasive and useful for symptom relief and preliminary assessment, mesothelioma cytology alone is often insufficient for a definitive diagnosis.
Fluid-based biopsies frequently yield limited cellular material and have lower sensitivity, with a higher risk of indeterminate or false-negative results compared with tissue biopsies. As a result, they are generally considered supportive rather than diagnostic and are often followed by tissue sampling when clinical suspicion remains high.
There are three main types of fluid removal procedures used when mesothelioma is suspected. They are categorized by the anatomic site from which the fluid is collected.
Thoracentesis
A thoracentesis is a medical procedure to remove excess fluid from the space between lungs and the chest wall, called the pleura. Once removed, the fluid can be used as a biopsy to provide evidence of pleural mesothelioma.
A small incision is made in the chest and a small tube or needle is inserted through the incision into the pleural space. Doctors remove the excess fluid and will send it to the pathology lab for evaluation for mesothelioma.. This procedure can also be used as a palliative treatment for late-stage pleural mesothelioma.
Paracentesis
A paracentesis is a medical procedure to remove excess fluid from the abdominal cavity. The fluid can be used as a biopsy to provide evidence of peritoneal mesothelioma.
A small incision is made in the abdomen and a small tube is inserted through the incision and into the abdominal cavity. Doctors remove fluid from the peritoneum or affected area and test it for mesothelioma. This procedure is also a palliative treatment for advanced peritoneal mesothelioma.
Pericardiocentesis
A pericardiocentesis is a medical procedure used to remove excess fluid from the sac around the heart, called the pericardium. The fluid removed can be used as a biopsy to provide evidence of pericardial mesothelioma.
A small needle or catheter is inserted into the pericardium, which is the lining around the heart, often with the assistance of ultrasound imaging. Doctors remove fluid from the area and send it to the pathology lab for examination. A pericardiocentesis is also used as a palliative treatment to relieve pain and decrease life threatening cardiac symptoms for patients suffering from severe fluid buildup in the pericardium.
Which Mesothelioma Biopsy Is Right For You?
Not every patient will undergo the same biopsy procedures. The location of tumors or abnormal thickening are factors. Another is if there is metastatic disease seen on imaging scans.
For instance, less-invasive camera-assisted needle biopsies may help early-stage patients. The disease has not spread far, so doctors won’t need to view the entire chest cavity or abdomen. Late-stage patients may need an invasive approach to uncover the extent of tumor spread.
Seeing a mesothelioma specialist is crucial after receiving a diagnosis of mesothelioma. Patients can rely on the expertise and knowledge of the specialists to ensure they receive the best treatment options for their specific needs. Specialists also work closely with other medical professionals who have seen and treated patients with mesothelioma, improving the chances of an accurate diagnosis and specialized care.
Misdiagnosis is not uncommon with this rare cancer, so we urge you to prioritize experience and expertise when seeking medical care. For more information on how to find a mesothelioma specialist, use our free Doctor Match program.
Frequently Asked Questions About Mesothelioma Biopsies
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 in the lining of the lungs, are:
Which types of biopsies are used for peritoneal mesothelioma?
Peritoneal mesothelioma, which forms in the lining of the abdominal cavity, is diagnosed by analyzing tissue or fluid removed from the abdomen. The biopsy procedures a doctor may use are:
Which biopsy is best for detecting mesothelioma?
Tissue biopsies are 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 and ultrasound imaging has made tissue biopsies much less invasive than decades ago.
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 to get a definitive diagnosis. The next step would be to find a mesothelioma specialist to determine the best treatment options for your specific needs.
Sources & Author
- Presentation, initial evaluation, and prognosis of malignant pleural mesothelioma. UpToDate. Retrieved from: https://www.uptodate.com/contents/presentation-initial-evaluation-and-prognosis-of-malignant-pleural-mesothelioma?topicRef=4625&source=see_link. Accessed: 03/19/19.
- Tests for Malignant Mesothelioma. American Cancer Society. Retrieved from: https://www.cancer.org/cancer/malignant-mesothelioma/detection-diagnosis-staging/how-diagnosed.html. Accessed: 05/05/2020.
- Types of biopsies used to look for cancer. American Cancer Society. Retrieved from: https://www.cancer.org/treatment/understanding-your-diagnosis/tests/testing-biopsy-and-cytology-specimens-for-cancer/biopsy-types.html. Accessed: 05/05/2020.
- The Accuracy of Video-Assisted Thoracic Surgery Pleural Biopsy in Patients with Suspected Diffuse Pleural Mesothelioma: A Real-Life Study. Journal of Clinical Medicine. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/41517292/. Accessed: 01/20/2025.
AI Summary of Mesothelioma Biopsy
A biopsy is an essential step in diagnosing mesothelioma, a rare cancer that affects the lining of the lungs or abdomen. This procedure involves collecting small samples of tissue or fluid from the suspected area, which are then examined closely under a microscope. Because mesothelioma can resemble other diseases, a biopsy provides the most accurate way to confirm the presence of cancer cells and determine the form of the disease. Depending on where abnormalities are found, different types of biopsies may be performed, with tissue biopsies being the most reliable method for an accurate diagnosis.
Before a biopsy, patients usually undergo imaging tests such as X-rays, CT scans, or PET scans. These help locate suspicious areas and guide doctors to the best site for tissue or fluid collection. Surgical biopsies, which involve removing larger tissue samples, are often performed when more detailed examination is needed. Less invasive methods, like needle biopsies, can also be used to extract smaller tissue samples or fluid from the chest or abdomen. In many cases, minimally invasive procedures assisted by cameras, such as thoracoscopy or laparoscopy, are preferred because they cause less discomfort and promote quicker recovery. These methods allow doctors to view the affected area directly and collect samples with high precision, often leading to more accurate diagnosis results.
There are also specialized procedures used when mesothelioma involves the lining around the heart or lymph nodes, including mediastinoscopy. Additionally, fluid samples can be obtained through procedures like thoracentesis or paracentesis, which involve removing excess fluid from the chest or abdomen. While fluid biopsies are less invasive and useful for symptom relief, they are typically less reliable on their own for diagnosing mesothelioma. Combining fluid analysis with tissue biopsies enhances overall accuracy and helps doctors determine the most effective treatment options. Each biopsy type is chosen based on the location of the disease and the overall health and circumstances of the patient, ensuring a tailored approach to diagnosis and care.