Mesothelioma Biopsy

A biopsy is the only definitive way to diagnose mesothelioma. Doctors perform biopsies to acquire tissue or fluid samples. These samples go through testing to determine whether or not the patient has mesothelioma.

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Written by Jenna Campagna, RN

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Important Facts About Mesothelioma Biopsies

  • The two types of biopsies for mesothelioma are tissue and fluid. Tissue samples for biopsies are more conclusive to diagnose.
  • Developments in surgery allow doctors to make small incisions and use camera-assisted needles to remove small tissue samples. Prior to this, doctors had to make large incisions to get tissue from a patient.
  • The type of biopsy used depends on where the abnormalities exist. Most with mesothelioma have a biopsy of the chest or stomach.

What Is Involved in a Mesothelioma Biopsy?

A biopsy is a medical procedure to extract tissue or fluid from the body. Doctors perform a mesothelioma biopsy in one of the areas where this cancer originates. Mesothelioma forms in 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 extract tissue. Needle biopsies remove fluid samples or smaller amounts of tissue. 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.

26%

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By comparison, camera-assisted tissue biopsies correctly diagnosed 98% of cases.

98%

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What Tests Happen Before a Biopsy?

Several procedures are in the mesothelioma diagnostic process. 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.While these scans are helpful, biopsies are the only conclusive way to determine cancer cells’ presence.

Surgical Mesothelioma Biopsies

A surgical biopsy involves extracting bodily tissue. Your body’s tissue has cells, some of which can be diseased. The extracted sample will either confirm or deny the presence of diseased cells. If the diseased cells are mesothelial cells, then they are evidence of mesothelioma.

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 cells are diseased.

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

Camera-assisted biopsies, also called endoscopic biopsies, make a tiny incision and use a tube-like instrument to look inside the body. Doctors can 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 biopsy procedures for each method. The type of biopsy you’ll undergo depends on where doctors believe your cancer exists.

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Thoracotomy

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

A thoracotomy allows surgeons a firsthand look at the disease in the chest cavity. This allows a view of the pleura, where the tumors started, and other areas to analyze how far the cancer has spread. Getting this close-up view helps doctors with staging and determining if surgery is possible.

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Laparotomy

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

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

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Thoracoscopy

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

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 metastasis. They also can use a needle to remove tissue for testing.

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Laparoscopy

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). Doctors insert the camera through a small incision in the abdomen. Surgeons often use a needle to remove a small amount of tissue. They also use the laparoscope to examine organs, which can determine the tumors’ spread.

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Mediastinoscopy

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

This procedure examines the mediastinum, which is the space between your lungs and behind your breastbone (sternum). Doctors insert a thin, lighted tube (mediastinoscope) with a camera attached. If tumors exist, then the disease is advanced (stage 3 or stage 4).

Doctors also can remove tissue samples from the lymph nodes to get a definitive answer of whether mesothelioma cells are present.

Non-Surgical/Fluid Biopsies for Mesothelioma

Non-surgical mesothelioma biopsies extract 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.

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

There are three types of non-surgical or needle mesothelioma biopsies. They differ by area of the body.

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Thoracentesis

A thoracentesis is a needle biopsy used to 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. This procedure is also a pain-relief surgery for late-stage pleural mesothelioma.

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Paracentesis

A paracentesis is a needle biopsy to obtain fluid samples from the abdomen. This procedure provides evidence of peritoneal mesothelioma.

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

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Pericardiocentesis

A pericardiocentesis is a needle biopsy to obtain fluid from near the heart. This procedure is best if doctors believe a patient has 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. A pericardiocentesis also provides 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 early-stage patients. The disease has not spread far, so doctors won’t need to view the entire thorax or abdomen. Late-stage patients may need an invasive approach to uncover all tumor spread.

Seeing a specialist is crucial for people may have mesothelioma. They can get their tissue or fluid sample examined by a pathologist and improve their chances of an accurate 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 get a biopsy, use our free Doctor Match program to connect 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: March 22, 2021.

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