Biphasic Mesothelioma

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Biphasic mesothelioma is a mixture of epithelioid and sarcomatoid cells. For a tumor to be diagnosed as biphasic, each cell type must make up at least 10 percent of it. This is most common in pleural mesothelioma cases. A higher percentage of sarcomatoid cells indicates a more aggressive cancer.

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Patient Advocate Karen Selby explains biphasic mesothelioma.
Patient Advocate Karen Selby explains biphasic mesothelioma.

What Is Biphasic Mesothelioma?

Malignant biphasic mesothelioma is the second most common cell type of the disease.

The life expectancy of patients with this form of cancer varies because prognosis depends on the ratio of epithelial and sarcomatoid cells.

The larger the percentage of sarcomatoid cells, the poorer the prognosis. This cell type is more common among pleural patients than peritoneal patients.

Understanding the characteristics and diagnosis of this type of mesothelioma can help you make informed treatment decisions with your doctor.

Biphasic Characteristics

In biphasic cases, epithelioid cells and sarcomatoid cells can exist close together. They can also appear within separate areas of a tumor.

These cell types are important to detect because some clinical trials and treatments target specific cell types. The characteristics of your cell type do not affect your symptoms. They may only affect your life expectancy by a few months.


Epithelioid mesothelioma has round, cube-like cells with long and slender microvilli, which are small hair-like protrusions in the cell membrane.


Biphasic mesothelioma is often called the “mixed” cell type because it has cells from both mesothelioma cell types.


Sarcomatoid mesothelioma is made up of spindle-shaped cells arranged in a disorganized fashion.

Biphasic Mesothelioma Diagnosis

This type can be difficult to detect and diagnose.

During a key diagnostic test, called biopsy, doctors may collect only a small sample of tissue to study in the lab.

Taking samples from just one location offers a limited view of the type and amount of mesothelioma cells involved.

Doctors can make a more accurate diagnosis by taking tissue samples from several parts of the tumor. Determining the specific cell type is important to the diagnostic process because it can affect your treatment options and prognosis.

Preventing a Misdiagnosis

Doctors use advanced tests, such as immunohistochemistry, to distinguish biphasic mesothelioma from other diseases that are easily confused with this cancer. This technique can detect certain proteins, revealing the specific type of abnormal cells.

Quick Fact:

The diagnostic process can be harder for biphasic patients since epithelioid and sarcomatoid cells must both be detected.

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With this information, doctors can rule out common misdiagnoses, including cancers like synovial sarcoma and carcinosarcoma.

A recent study published in the Journal of Thoracic Oncology found the biphasic type can be misdiagnosed after a biopsy. A total of 83 patients in the study were confirmed to have this type of pleural cancer after undergoing an extensive surgical procedure called an extrapleural pneumonectomy.

However, only 26 percent of those patients had been originally diagnosed with this subtype. The authors explained biphasic mesothelioma can be more accurately diagnosed following surgery. The initial diagnostic methods included thoracoscopy, thoracotomy, computerized tomography and other biopsy methods.


Patients with the biphasic cell type may not be considered for an aggressive treatment plan as would patients with the epithelioid type.

The reason is that biphasic carries a slightly poorer prognosis than epithelioid. However, treatment is not completely based on cell type.

Most patients undergo one or more of the three most common therapies, including:

  • Surgery
  • Chemotherapy
  • Radiation

Treatment generally depends more on the stage and location of the tumor than the cell type involved.

Biphasic Prognosis

The prognosis for patients with biphasic mesothelioma varies depending on the ratio of epithelial and sarcomatoid cells present in each case.

Quick Fact:

The more epithelial cells you have in a biphasic mix, the better your prognosis may be. How much better may amount to only a few months depending on the case.

In one study involving 85 pleural mesothelioma patients with a variety of cellular subtypes, people with the biphasic subtype had an average survival of about 15 months. Those with the epithelial subtype displayed the highest average survival — more than 22 months.

The researchers observed slightly better survival among biphasic patients whose tumors had mostly epithelial cells, compared to those with mostly sarcomatoid cells. While the survival advantage was only 16 days, sarcomatoid cells are less responsive to treatment than epithelial cells. As a result, biphasic patients with a lower number of sarcomatoid cells tend to see better results from treatment.

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Registered Nurse and Patient Advocate

Karen Selby joined in 2009. She is a registered nurse with a background in oncology and thoracic surgery and was the regional director of a tissue bank before becoming a Patient Advocate at The Mesothelioma Center. Karen has assisted surgeons with thoracic surgeries such as lung resections, lung transplants, pneumonectomies, pleurectomies and wedge resections. She is also a member of the Academy of Oncology Nurse & Patient Navigators.

Walter Pacheco, Managing Editor at
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7 Cited Article Sources

  1. American Cancer Society. (2016, February 17). About Malignant Mesothelioma. Retrieved from:
  2. Dodson, R. & Hammar, S. Asbestos: Risk Assessment, Epidemiology, and Health Effects. Taylor & Francis: Boca Raton, 2006.
  3. Galateau-Salle, F. Pathology of Malignant Mesothelioma. Springer-Verlag London Limited: London, 2006.
  4. Pass, I., Vogelzang, N. & Carbone, M. Malignant Mesothelioma: Advances in Pathogenesis, Diagnosis, and Transitional Therapies. Springer: New York, 2005.
  5. Bruce, W., Robinson, A. & Chahinian, P. Mesothelioma. Informa Health Care, 2002. (ISBN 9058231801).
  6. "Accuracy of Diagnostic Biopsy for the Histological Subtype of Malignant Pleural Mesothelioma." Journal of Thoracic Oncology. 6.3 (2011): 602-5.
  7. "Diffuse Malignant Mesothelioma of the Peritoneum and Pleura, analysis of markers." Modern Pathology. 17 (2004): 476-81.

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Last Modified July 15, 2019

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