A biopsy is the only sure way to diagnose mesothelioma. A mesothelioma biopsy collects tissue or fluid to check for cancer. Doctors may recommend biopsies for people with symptoms of mesothelioma or a known history of asbestos exposure.
Fact Checked
| Written by:
Dr. Daniel Landau
| Last Update: 07/24/2025
| 9 Min Read
A mesothelioma biopsy is a medical test. Your doctor collects 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
Doctors need a biopsy for an accurate mesothelioma diagnosis.
Biopsies can sample tumors and lymph nodes for cancer cells.
Biopsies can help find out if cancer has spread.
Pleural mesothelioma biopsies often use video-assisted thoracoscopic surgery.
Peritoneal mesothelioma involves core needle biopsy or laparoscopic biopsy.
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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.
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.
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 pleural mesothelioma and stage it. 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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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 done as an outpatient procedure with local anesthesia. It uses a long, hollow needle attached to a syringe to remove up to 10,000 sample cells for analysis. Your doctor will usually use 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.
Diagram shows how a fine-needle biopsy is collected.
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.
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.
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.
Post-procedure care: After removing the needle, your doctor will clean and bandage your incision. It won’t require stitches.
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.
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.
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 get ready for your biopsy.
Tips to Prepare for a Biopsy
Follow pre-procedure instructions: Your prep notes will likely recommend you leave valuables at home, take off jewelry and wear comfortable clothes on the day of your procedure. There may also be directions to not eat or drink beforehand.
Medication management: You’ll list all the medications you take, 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 be required to make sure you have someone to give you a ride to and from the appointment. Your procedure could even be delayed or canceled without having someone there to drive 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 for your 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 for you.
It’s important that both your doctor and the 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.
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Dr. Daniel Landau is the Medical Director of Virtual Hematology at the Medical University of South Carolina in Charleston. He has served in several leadership roles and developed telehealth services at several cancer centers.
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