Mesothelioma Biopsy

Expert Fact Checked

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James Stevenson, M.D. Thoracic Medical Oncologist

A mesothelioma biopsy procedure removes a sample of tissue or fluid to determine if it is cancerous. Testing a biopsy sample is the only definitive way to confirm a patient has malignant mesothelioma. Doctors may order a biopsy if imaging scans or blood tests do not provide a diagnosis. Biopsy analysis may find cancer or other conditions.

01. What Is a Biopsy?

What Is a Mesothelioma Biopsy?

A biopsy is a medical procedure where doctors collect a tissue or fluid sample from a patient. The collected sample is sent out to a pathologist for analysis. A pathologist is a healthcare provider who examines tissues by performing lab tests.

Doctors use this analysis to determine if a tumor is cancerous (malignant) or noncancerous (benign). Testing a biopsy sample is the only way to confirm a mesothelioma diagnosis. However, doctors may also conduct other tests to assess disease characteristics or rule out specific concerns. Other tests used during the mesothelioma diagnostic process include physical examinations, imaging scans and blood tests.

If imaging scans or other tests show abnormalities, doctors may perform a biopsy. Biopsy procedures vary in invasiveness, depending on the specific type of biopsy.

A Biopsy Helps Doctors Diagnose Mesothelioma

A biopsy is one of various diagnostic tools doctors use for mesothelioma. But testing a mesothelioma biopsy is the only definitive way to confirm a diagnosis of mesothelioma. After the biopsy procedure, analysis of the sample can confirm a patient has mesothelioma.

Mesothelioma biopsies can analyze two different kinds of samples: fluid and tissue. A primary difference between these is that tissue biopsies are required for a mesothelioma diagnosis.

Tissue vs Fluid Biopsy

Tissue Biopsy
  • A tissue biopsy removes a small amount of tissue, usually with a hollow needle or sharp instrument.
  • Doctors may send the tissue sample to a lab for biopsy testing.
  • Testing a tissue biopsy is the only definitive way to diagnose mesothelioma. It may also help determine characteristics like mesothelioma cell type.
Fluid Biopsy
  • A fluid biopsy removes only fluid, usually with a needle or hollow tube and simple suction.
  • Doctors may send the fluid and any cells it contains to a lab for testing.
  • A fluid biopsy is unlikely to confirm a mesothelioma diagnosis. But it may help determine characteristics like the type of mesothelioma.

Doctors may use biopsies to assess other mesothelioma characteristics, too. For example, a biopsy analysis can determine cell type (epithelioid, sarcomatoid or biphasic). Along with imaging tests, a biopsy may also help doctors determine the mesothelioma stage.

Accurate type and stage help mesothelioma doctors create a personalized treatment plan. These doctors can determine which mesothelioma treatment options are best for each case. Quick and accurate diagnostic results also help patients begin treatment as soon as possible.

02. Types of Biopsies

Types of Mesothelioma Biopsies

There are several types of biopsies used to diagnose mesothelioma. The location of the tumor determines which biopsy a doctor will use. Tumor location can also help indicate the type of mesothelioma. Some biopsies are used more often with certain mesothelioma types.

Common types of mesothelioma biopsies are needle biopsies, camera-assisted biopsies and surgical biopsies.

Needle Biopsies

In general, needle biopsies are minimally invasive procedures. They are usually quick to perform and require little to no recovery time. Doctors may use different types of needle biopsies for mesothelioma.

One type is a core needle biopsy. This minimally invasive procedure may be paired with a CT scan or ultrasound. The doctor uses a hollow needle to remove a small cylinder of tissue from the potential tumor site. The tissue sample is then analyzed by pathologists. Needle biopsies may also collect lymph node tissue samples to help determine cancer metastasis (spread).

Needle Biopsy Procedure Overview

  • Patients are commonly awake during the procedure, with local anesthesia applied to the area.
  • With a needle, physicians extract tissue near the site that may contain cancer cells.
  • Physicians may use ultrasounds or other imaging tools to help guide needle placement.
  • For some patients, a needle biopsy may not provide a diagnosis. In these cases, doctors may recommend a surgical biopsy.

Diagnosing mesothelioma with a pleural needle biopsy.

Another type, called fluid biopsies, drain and test fluid around the tumor site. Fluid biopsies can also be useful as a palliative treatment. The biopsy can help relieve fluid buildup and pressure around the organs. This can help manage mesothelioma symptoms.

  • Thoracentesis (pleurocentesis): A procedure that drains fluid from the space between the layers of the pleura. On its own, it is generally not capable of diagnosing pleural mesothelioma. But thoracentesis may still be a helpful diagnostic tool. Doctors may also use it palliatively to treat fluid buildup, called pleural effusion.
  • Paracentesis: A procedure that drains excess fluid from the lining around the abdomen (peritoneum). On its own, it is generally not capable of diagnosing peritoneal mesothelioma. But paracentesis may still be a helpful diagnostic tool. Doctors may also use it palliatively to treat fluid buildup, called peritoneal effusion.
  • Pericardiocentesis: A procedure that drains fluid from within the membrane around the heart (pericardium). On its own, it is generally not capable of diagnosing pericardial mesothelioma. But pericardiocentesis may still be a helpful diagnostic tool. Doctors may also use it palliatively to treat fluid buildup, called pericardial effusion.

Testing a tissue biopsy is the best way to confirm a mesothelioma diagnosis. Fluid biopsies are unlikely to provide enough information for a definitive diagnosis. Still, fluid biopsies can help during the diagnostic and treatment process. They can help oncologists assess other disease details and increase patients’ comfort.

Camera-Assisted Surgical Biopsies

Camera-assisted biopsies allow doctors to visually examine the affected tissue. They also allow for the collection of tissue samples for biopsies.

Some camera-assisted biopsies may be non-surgical. Doctors will decide which biopsy type to use based on various factors like the location of the tumor site.

Camera-assisted biopsies are also called endoscopic biopsies. There are several types of camera-assisted biopsies, which may or may not be surgical. This depends on the circumstances and equipment used.

In general, the process for surgical and non-surgical biopsies is similar.

Camera-Assisted Biopsy Procedure

  • The patient receives general anesthesia.
  • The surgeon makes a small incision and inserts a thin tube.
  • The tube contains a camera that guides needle insertion and removal of a tissue sample.
  • Some endoscopies take images during the procedure for later review.
  • The surgical team monitors patient vitals throughout the procedure.
  • Patients often go to a recovery room for a short period of time. Patients may need to plan in advance for someone else to drive them home after the procedure.

There are various subtypes of camera-assisted biopsies, each with unique purposes. Common types of camera-assisted mesothelioma biopsies include thoracoscopy, laparoscopy and mediastinoscopy.

  • Thoracoscopy: In this procedure, doctors pass a small camera through a tiny incision into the pleural space. The camera-equipped, tube-like instrument used in this procedure is called a thoracoscope. The instrument allows doctors to see the tissue inside the chest and take tissue samples. A thoracoscopy can provide an adequate tissue sample for diagnosing pleural mesothelioma.
  • Laparoscopy: In this procedure, doctors pass a small camera through an incision in the abdomen. A camera-equipped, tube-like instrument is used in this procedure, called a laparoscope. During this procedure, doctors may remove a sample of tissue in the abdominal cavity for analysis. Doctors often use laparoscopy to collect samples from patients with suspected peritoneal mesothelioma.
  • Mediastinoscopy: In this procedure, doctors pass a small lens or camera through an incision above the breastbone. This allows access into the space between the lungs (mediastinum). Doctors may examine the organs and tissues in the mediastinum. Mediastinoscopy may allow doctors to collect tissue samples for diagnostic biopsies.

Video-Assisted Thoracoscopy or VATS

Video-assisted thoracoscopic surgery (VATS) is the name for a specific type of camera-assisted biopsy procedure. Doctors use this type to examine the thoracic cavity. In VATS, the thoracoscope has a video camera rather than a regular scope or photo camera on the end.

For mesothelioma patients, doctors use VATS to investigate tumors in the chest. Like other camera-assisted biopsies, VATS is minimally invasive. Recovery is generally mild, but doctors will provide aftercare instructions. Once analyzed, doctors will discuss results with patients.

03. What to Expect

What to Expect During a Mesothelioma Biopsy

The patient experience is generally similar for most types of mesothelioma biopsies. Typically, patient preparation is minimal, and recovery is easy to manage. Doctors will explain the procedure to patients and answer any questions they have. There are some general guidelines mesothelioma patients can expect for biopsies.

  • Before biopsies: Patients may have some basic preparation steps. For example, patients may need to pause blood-thinning medications. They may also need to avoid eating or drinking before the procedure. In these cases, doctors will tell patients when to fast or pause their medication. Doctors also recommend wearing loose, comfortable clothing and removing jewelry for the biopsy.
  • During biopsies: Patients receive local or general anesthesia. Local anesthesia numbs the biopsy site. General anesthesia puts the patient in a sleep-like state for the biopsy. Then, the medical team will clean the incision site. Depending on the biopsy type, ultrasounds or other imaging tools may help guide doctors. Once doctors perform the biopsy, they will clean the area again before closing and bandaging it.
  • After biopsies: The medical team will give patients specific aftercare instructions. These often include rest, pain medication and gentle movement after a period of time. Healthcare providers will go over aftercare with patients and tell them about anything to watch out for. They can also give patients an idea of how long biopsy results will take.

Patients who receive biopsies can usually expect quick recovery with few and mild side effects.

04. Biopsy Results and Diagnosis

What Information Does a Mesothelioma Biopsy Provide?

Biopsy findings can confirm malignancy and cell type. A biopsy may give the doctor a better idea of metastasis. For instance, biopsy results may be used to help determine a patient’s clinical stage using the TNM staging system. But a biopsy is typically meant to collect tissue or fluid for further analysis.

Patients will typically have to wait a short time to learn their biopsy results. After doctors collect a sample from the tumor site, they send it for pathological analysis. The patient’s physician will review the results and discuss them with the patient.

An oncology team will also use biopsy information to understand a patient’s prognosis and develop a treatment plan. Mesothelioma patients may begin treatment soon after receiving their biopsy results. Needle biopsies may also help alleviate symptoms.

05. Common Questions

Common Questions About Mesothelioma Biopsies

Can mesothelioma be diagnosed without a biopsy?

No, mesothelioma cannot be diagnosed without a biopsy. Tests like CT scans and X-rays may be part of the diagnostic process. But these tests cannot confirm a mesothelioma diagnosis. Testing a tissue biopsy sample is the only way to diagnose mesothelioma definitively.

How long does it take to get a biopsy’s results?

In general, biopsy tissue test results may come back within two days after the sample arrives at the testing lab. Some samples may take longer depending on how much testing the lab does. In some cases, mesothelioma samples may also need further review from a mesothelioma expert. Doctors can give patients a timeline for results when completing the biopsy procedure.

Should I get a second opinion on my biopsy diagnosis?

Some experts recommend second opinions for diagnoses like mesothelioma. This disease may require surgery, chemotherapy, radiation or other aggressive treatments. A second opinion can help patients get the right treatment. In general, second opinions can be a good idea for major diagnoses and may take just a few days or a week.

Are biopsies covered by insurance?

Coverage of biopsies depends on patients’ individual insurance plans. Medicare Part B covers medically necessary clinical diagnostic tests that doctors order. Private insurance coverage varies on individual policies. Some patients’ insurance policies cover laboratory services like biopsies. Patients can connect with their insurance provider for a detailed explanation of benefits.