Mesothelioma Biopsy

What Is a Mesothelioma Biopsy?

A mesothelioma biopsy is a medical test using a sample of suspected cancer cells or tissue for lab testing. It’s the most accurate way to confirm mesothelioma, a cancer often mistaken for benign illnesses or other cancers.

Key Facts About Mesothelioma Biopsies

1. Only a biopsy can definitively confirm mesothelioma.
2. A fine-needle biopsy typically takes less than 10 minutes.
3. Biopsy results usually return within several days to a week.
4. Doctors most often diagnose pleural mesothelioma with video-assisted thoracoscopic surgery (VATS) and peritoneal mesothelioma with laparoscopy or core needle biopsy.
5. A pathologist who specializes in mesothelioma should review every biopsy sample.

Biopsy procedures can take 30 minutes to 3 hours. They may require general anesthesia. Your doctor then sends your biopsied cells to a pathologist. They’ll look for signs of cancer. Lab tests show if mesothelioma cells are present.

Biopsies often follow imaging scans and blood tests in the diagnostic process. The type of biopsy you’ll have depends on tumor location. There are several types of biopsies: an endoscopic biopsy, a fine-needle biopsy and a surgical biopsy. Doctors tailor each type of biopsy to access different body parts for an accurate diagnosis.

Endoscopic Mesothelioma Biopsies

Endoscopic biopsies are minimally invasive procedures used to diagnose mesothelioma. General anesthesia is needed. Overnight hospital stays are usually required, especially if the chest is involved. 

Your doctor will make a small incision. Then they’ll insert a long, thin, flexible tube with a light and camera called an endoscope. An endoscope will allow your doctor to find cancer cells and collect a tissue sample for testing.

Recovery from general anesthesia can take hours. You may feel groggy, confused and in pain. A short hospital stay ensures recovery before going home. Your doctor may prescribe antibiotics for up to a week.

Expert Insight

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

Types of Endoscopic Biopsies for Mesothelioma

There are several types of endoscopic biopsies. Doctors often choose endoscopic biopsies because they can collect large samples of tumors.

• Laparoscopy: This procedure can diagnose peritoneal mesothelioma. Your surgeon makes an abdominal incision to insert the endoscope. They may also make small incisions for other surgical tools. They examine the abdominal cavity and collect tissue and fluid. 
• Mediastinoscopy: This procedure can diagnose and stage pleural mesothelioma. Your surgeon may perform a mediastinoscopy while you’re undergoing a thoracoscopy. Your surgeon inserts an endoscope at the base of your neck to sample the lymph nodes around your windpipe.
• Thoracoscopy and video-assisted thoracoscopy: Your surgeon inserts an endoscope and tools through incisions in your chest. An endoscope can remove excess fluid, examine your chest and take tissue samples. VATS is a more complex type of thoracoscopy. VATS can collect large samples from multiple sites in the chest. 

Endoscopic biopsies can lead to bleeding and infection. After the procedure, your doctor may limit some activities. You may have stitches that need removal in 1 to 2 weeks.

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Fine-Needle Biopsy for Mesothelioma

A fine-needle biopsy for mesothelioma is a quicker, less invasive test than endoscopy. It’s not as effective as thoracoscopy for diagnosing pleural mesothelioma. But it can be a safer alternative for some people. It’s also effective in diagnosing peritoneal mesothelioma.

It’s usually an outpatient procedure with local anesthesia. A long, hollow needle attached to a syringe removes up to 10,000 sample cells for analysis. Your doctor usually uses an ultrasound or CT scan to guide the needle to the target.

This method is less risky than endoscopy, but there is a small risk of infection or bleeding. Lung biopsies can cause a collapsed lung or blood pooling around the lung (hemothorax). Coughing up a small amount of blood after a lung biopsy is normal.

Fine-Needle Biopsy Procedure

Before a fine-needle biopsy, talk to your doctor about what to expect. You may need to take medication for pain or anxiety before the procedure. 

1. Preparation: Your doctor will clean your skin and apply a local anesthetic to numb the area. They’ll position you for easy access to the biopsy site.
2. Procedure: Your doctor will use ultrasound or CT scans for guidance. They’ll insert a needle into the chest or abdomen to extract samples. The entire process usually takes less than 10 minutes.
3. Post-procedure care: After removing the needle, your doctor cleans and bandages your incision. It won’t require stitches.
4. Sample analysis: Your doctor sends the tissue samples to a pathology lab. Results usually take several days to a week or more.

You can go home after the procedure. Experiencing some pain is normal. Your doctor may recommend taking OTC pain meds. You’ll rest and limit activity for several days.

Thoracentesis and Paracentesis

Thoracentesis and paracentesis aren’t true biopsies, but they’re similar. Thoracentesis drains fluid from around the lungs. Paracentesis drains fluid from the abdomen. 

Your doctor will use local anesthesia. They’ll insert a long, blunt needle to drain fluid from the lining of the lung or abdomen. Lab tests help them determine the cause of your excess fluid.

Neither procedure can accurately diagnose mesothelioma. But they can aid diagnosis. Many other conditions cause excess fluid, so it’s important to rule them out. Removing fluid relieves symptoms of pleural effusion such as shortness of breath. It also improves abdominal swelling associated with ascites.

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.

Jim Madaris

Verified Asbestos.com Survivor

Read Jim’s Story

Surgical Mesothelioma Biopsies

Doctors don’t typically use surgical biopsies to diagnose mesothelioma. If an endoscopic or fine-needle biopsy isn’t possible, you may need surgery to find and biopsy tumors.

Your surgeon performs a surgical biopsy during open surgery. This lets your doctor see any tumors and collect large samples, including whole tumors. The type of biopsy you need depends on where mesothelioma is located in your body.

Types of Surgical Biopsies for Mesothelioma

• Laparotomy: This is an exploratory surgery in the abdomen. This procedure helps to diagnose peritoneal mesothelioma.
• Thoracotomy: The chest cavity or pleural space around the lungs is explored.

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 testing. It has the highest accuracy for diagnosing mesothelioma. But it also has the greatest risk of complications. 

Surgical biopsies require general anesthesia and large incisions. Any major surgery carries a high risk of bleeding, infection or other complications. Surgical biopsies require much more recovery time than less-invasive ones.

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.

Dr. Jacques Fontaine , director of the Mesothelioma Research and Treatment Center at Moffitt Cancer Center

How You Can Prepare for a Mesothelioma Biopsy

Preparation for a mesothelioma biopsy depends on the type of procedure you’re having. Your doctor will provide clear instructions about what to do before the procedure. Asking your health care team questions is one of the best ways to prepare for your biopsy.

Tips to Prepare for a Biopsy

• Follow pre-procedure instructions: Your prep notes will likely recommend you leave valuables at home, remove jewelry and wear comfortable clothes on the day of your procedure. You may be told not to eat or drink beforehand.
• Medication management: You’ll list all your medications, including OTC drugs, supplements or vitamins. Your doctor may tell you to pause taking blood thinners like Coumadin, Heparin or aspirin for a short time to lower the chance of bleeding.
• Transportation from the procedure: If you’ll be under general anesthesia, you’ll likely need someone to take you to and from the appointment. Your procedure could be delayed or canceled without someone driving you home. 
• Packing for an overnight stay: If you’ll be staying overnight, pack a bag with everything you’ll need. This could include a change of clothes and a phone charger.
• Aftercare and reviewing results: Ask your doctor what to expect after the procedure. Ask when you can expect to receive your biopsy results and when you’ll discuss them with your doctor.

Your care team may ask permission to speak with a trusted friend or family member about your procedure and next steps. This is important because anesthesia can sometimes affect memory after the procedure. Having someone else informed helps ensure you don’t miss any important information.

Understanding Your Biopsy Results and Next Steps

After your biopsy, your doctor will receive a report with important findings. This report identifies key details like the specific mesothelioma cell type found. Your doctor combines this information with imaging scans to determine the progression or stage of your mesothelioma. This information will guide a personalized treatment plan.

It’s important that your doctor and pathologist reviewing your biopsy have experience with mesothelioma, ensuring accurate interpretation. To prepare for your appointment, write down some questions ahead of time so you can understand the findings and next steps clearly.

Coping with a mesothelioma diagnosis can be overwhelming, but you’re not alone. The Mesothelioma Center offers support and resources to help you and your family through every step of your journey.

Common Questions About Mesothelioma Biopsies

What does a mesothelioma biopsy involve?

A mesothelioma biopsy collects a small sample of tissue or fluid, usually from the lung or abdominal lining, so a pathologist can examine the cells under a microscope. A biopsy is the only test that can definitively confirm mesothelioma.

How long does it take to get mesothelioma biopsy results?

Most patients receive mesothelioma biopsy results within several days to a week. The tissue sample is sent to a pathology lab where it is reviewed under a microscope, often followed by immunohistochemistry testing to confirm the cell type (epithelioid, sarcomatoid or biphasic). Complex cases reviewed by a mesothelioma-specialist pathologist may take longer because the diagnosis often requires additional staining and genetic testing.

Is a mesothelioma biopsy painful?

Most mesothelioma biopsies are not painful at the time of the procedure because doctors use local or general anesthesia. Patients may feel mild soreness, bruising or discomfort at the incision site for several days afterward. Your doctor will give you specific recovery and pain-management instructions before discharge.

What is the difference between a needle biopsy and a surgical biopsy for mesothelioma?

A needle biopsy uses a thin needle, guided by ultrasound or CT imaging, to extract a small tissue sample. It typically uses local anesthesia and takes less than 10 minutes. A surgical biopsy (such as thoracoscopy, VATS, laparoscopy or thoracotomy) requires general anesthesia and small incisions so the surgeon can examine the chest or abdominal cavity directly and remove a larger tissue sample. Doctors generally prefer surgical biopsies for mesothelioma because the larger sample improves diagnostic accuracy, especially for distinguishing cell subtypes.

Why is pathologist expertise important for a mesothelioma biopsy?

Mesothelioma cells can closely resemble cells from other cancers such as lung adenocarcinoma under a microscope, so a pathologist who has not seen many mesothelioma samples can misread even an accurate biopsy. Specialist pathologists use immunohistochemistry markers and genetic testing to confirm the diagnosis and identify the cell subtype, which directly determines treatment options. A specialist pathologist at a comprehensive cancer center should review every mesothelioma biopsy.

Can a biopsy spread mesothelioma?

A biopsy rarely spreads mesothelioma. Tumor cells can occasionally spread along the path of the needle or instrument, a process called tract seeding, but this is uncommon with modern biopsy procedures. The SMART trial, published in The Lancet Oncology in 2016, found that preventive radiation to the biopsy site does not significantly reduce this risk and is not routinely recommended.

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