What Is a Mesothelioma Biopsy?

A mesothelioma biopsy is a medical procedure used to remove a sample of tissue to examine for signs of mesothelioma cancer. A combination of biopsies, imaging scans and blood tests help to diagnose mesothelioma. A biopsy is the most accurate way to confirm the presence of cancerous cells.

There are two primary steps in a biopsy: Collection of tissue samples and testing of those samples. A pathologist views the sample under a microscope to determine if cancer is present.

Mesothelioma Biopsy Facts

  • Involves removing tissue that may be cancerous for microscope analysis
  • Necessary for accurate mesothelioma diagnosis
  • Video-assisted thoracoscopic surgery (VATS) is most common for pleural mesothelioma
  • Fine-needle aspiration is common for peritoneal mesothelioma

A mesothelioma biopsy is necessary to confirm the specific cell type of mesothelioma a patient has. Doctors can mistake mesothelioma for common benign illnesses or other types of cancer. It can take several days to a week or more to receive biopsy results.

Patients at risk of peritoneal mesothelioma undergo a fine-needle aspiration biopsy. Video-assisted thoracoscopic surgery is more effective for pleural mesothelioma.

Endoscopic Mesothelioma Biopsies

Endoscopic biopsies are noninvasive procedures. They involve inserting a small tube with a camera into the body to visualize tissue for testing.

Endoscopic Biopsy Procedure

  1. The patient receives general anesthesia.
  2. The surgeon inserts an endoscope into the chest or abdominal cavity. The camera identifies tissue that appears cancerous for collection.
  3. The surgeon uses a tool to extract tissue samples. Removal of the endoscope may involve sealing an incision, depending upon the procedure.
  4. The patient then goes to a recovery room for monitoring while the anesthesia wears off.
  5. A pathology lab analyzes the tizzue sample.

An endoscope is a thin, tube-shaped instrument with a light and a camera on the end. It looks inside the patient’s body without the need to make a major incision.

Types of Endoscopic Biopsies for Mesothelioma

A 2008 study compared the accuracy of several biopsy techniques. Thoracoscopy had the highest diagnostic accuracy, confirming a diagnosis in 95% of patients with the disease.

Thoracoscopy

A surgeon inserts an endoscope between the ribs. It removes excess fluid, examines the appearance of the inside of the chest and takes tissue samples. This procedure is for patients suspected of having pleural mesothelioma.

Mediastinoscopy

A surgeon inserts an endoscope at the base of the neck to obtain tissue samples of the lymph nodes around the windpipe. This can help diagnose cases of pleural mesothelioma, and it can provide evidence to determine the stage of mesothelioma.

Laparoscopy

A surgeon makes an abdominal incision and then inserts an endoscope. It examines the abdominal cavity and collects samples of suspicious tissue. This procedure is for patients suspected of having peritoneal mesothelioma.

Video-Assisted Thoracoscopy (VATS)

Thoracoscopic biopsy has a remarkable track record of accurate pleural mesothelioma diagnoses. It allows doctors to see into the pleural space to check cancer spread and retrieve tissue samples.

A thoracoscopy remains the most accurate biopsy technique to diagnose pleural mesothelioma. A 2022 study published in the journal Cancers confirmed its accuracy.

Fine-Needle Biopsy for Mesothelioma

Fine-needle aspiration is a quick and safe biopsy procedure. It uses a long, hollow needle attached to a syringe to remove up to 10,000 sample cells for analysis. Imagery from a CT scan or ultrasound helps guide the small needle. Patients receive local anesthesia.

Percutaneous Needle Core Lung Biopsy: An illustration depicts a needle passing through layers of skin and muscle tissue to enter the lung and extract cellular fluid for a biopsy sample from a target mass.

A risk associated with fine-needle aspiration includes hemothorax. This is when blood collects in the pleural space between the chest wall and the lung.

Fine-Needle Biopsy Procedure

  1. The patient’s skin is cleaned and local anesthesia is applied to the area where the needle will be inserted. The patient will be positioned so that the doctor can easily perform the procedure.
  2. An ultrasound or CT scan may be used to determine where to insert the needle. The doctor will then insert the needle into the chest or abdominal cavity to extract tissue. The needle is attached to a syringe that contains a vacuum to collect tissue samples. The procedure is typically performed in less than 10 minutes.
  3. Once the needle is removed, the incision is cleaned and bandaged. No sutures are needed.
  4. Tissue samples are sent to a pathology lab for analysis. It could take several days to a week or longer to get results.

Needle biopsies are not as effective for diagnosing pleural mesothelioma as thoracoscopic surgery. The latter has a diagnostic sensitivity of 80%.

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Similar Procedures

While not considered true biopsy procedures, a thoracentesis and paracentesis are treatments for fluid buildup around the lungs and abdomen, respectively, that can provide fluid biopsy samples.

Thoracentesis

Performed under local anesthesia, this procedure drains fluid from around the lungs. A doctor uses an ultrasound probe to guide a small needle between the ribs in the back to remove pleural fluid buildup. It only collects fluid, not tissue, so it cannot provide an official mesothelioma diagnosis. It is used to determine the cause of pleural effusions.

Paracentesis

This procedure removes fluid buildup in the peritoneum. It is performed the same way as a thoracentesis, but in the abdomen. It can determine the cause of ascites, or fluid buildup in the peritoneum, but it cannot provide an accurate diagnosis for mesothelioma because it does not collect tissue samples.

Surgical Mesothelioma Biopsies

Tissue samples collected during surgery are called surgical biopsies. These are not very common for peritoneal mesothelioma, and they are extremely uncommon for pleural mesothelioma.

Types of Surgical Biopsies for Mesothelioma
Laparotomy

Exploratory surgery of the abdomen involves a laparotomy. It opens the abdomen and allows surgeons to collect tissue samples and remove suspicious tissue. Exploratory surgery is safer to perform on the abdomen compared to the chest.

Thoracotomy

A thoracotomy allows surgeons to open the chest to collect tissue samples. This procedure is generally not performed on patients suspected of having cancer in their chest.

When surgery is performed on patients with pleural mesothelioma, surgeons attempt to remove as much of the malignant mesothelioma cancer as possible. This procedure provides the most tissue for analysis, which can help to determine the cell type of a mesothelioma tumor.

In some instances, it is not possible to perform a thoracoscopic biopsy as there is no pleural space and tumors have grown all around the lung. If that happens, a percutaneous needle biopsy is possible but will provide a small sample. 

The alternative is to perform an open pleural biopsy through a limited incision. This is usually performed under general anesthesia.

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