Biopsies are the only definitive way to diagnose mesothelioma. While other tests can detect the potential presence of a tumor, a tissue sample taken by biopsy can be examined under a microscope to determine the mesothelioma cell type and other characteristics.
By nature, biopsies are invasive procedures, though the level of invasiveness differs greatly depending on the type of biopsy a patient undergoes. This page provides information about each of these types of biopsy and how they affect mesothelioma patients during the diagnostic process.
Mesothelioma Biopsy Quick Facts
- Biopsies are the only method of confirming a mesothelioma diagnosis.
- There are three types of biopsy: needle, camera-assisted, and surgical.
- After a tissue sample is taken, it is sent to a lab for histological analysis.
- Biopsies help doctors determine a mesothelioma patient’s prognosis.
When are biopsies performed?
In most cases, taking a biopsy is the last stage of the mesothelioma diagnosis process. If the patient’s symptoms, imaging tests, and blood tests all point to the potential for mesothelioma, the doctor will typically order a biopsy to be performed to confirm the diagnosis positively.
The biggest reason that biopsies are held until all the other tests are performed is that they are invasive by nature. Many biopsies are surgical procedures in themselves, and therefore come with the same risks that other surgeries carry, including infection or other complications. As a result, biopsies are only performed if the signs all point to mesothelioma (or some other form of cancer).
Mesothelioma Biopsy Types
There are three primary types of biopsies that mesothelioma patients may undergo: needle biopsies, camera-assisted biopsies, and open surgery biopsies. Which biopsy procedure is recommended depends on the location of the tumor or where mesothelioma symptoms are presenting (such as fluid buildup around the lungs).
Needle biopsies are considered closed (i.e., non-surgical) procedures. The procedure uses either a small- or large-bore needle to extract fluid containing cancer cells from around the area of the tumor.
In most cases, patients are awake during needle biopsies. The doctor may use an ultrasound or CT camera guidance to help guide needle placement.
The benefit of needle biopsies is that the procedure is very fast, it does not severely impact the body, and it requires little or no recovery time. However, needle biopsies are also limited in that they may not pick up enough cancer cells to perform the histological analysis required for a definitive diagnosis. Therefore, in some cases, doctors may follow up with a surgical biopsy if the needle biopsy comes back negative for mesothelioma.
Needle Biopsy Types
A thoracentesis is most often performed to remove fluid from the space between the lungs and the chest wall. Most commonly, the doctor will numb the area with a local anesthetic and then insert the needle in the patient’s back along the midscapular line (about midway between the spine and flank). After the fluid is drained, the needle will be removed and the area will be covered with a sterile bandage.
A paracentesis is performed to remove excess fluid from around the abdomen. Typically, the area where the needle is to be inserted will be shaved, cleaned, and numbed with a local anesthetic. The doctor will then insert a fine needle into the abdominal area and drain the fluid into a syringe. If a very large amount of fluid is present, a catheter may be mounted to the syringe so that fluid can be collected in a vacuum bottle. When enough fluid is collected, the needle will be withdrawn and the area will be covered with a sterile bandage.
A pericardiocentesis is performed to remove excess fluid from the thin space between the heart and the pericardium. With this type of biopsy, the doctor will sterilize and numb an area of the chest immediately below the sternum where the needle will be inserted. An echocardiogram is often used to help guide needle placement during the procedure. After the biopsy, the needle is withdrawn and the area is covered with a sterile bandage. In some cases, a catheter may be inserted to allow fluid to continue draining.
In addition to using these procedures to obtain tissue samples as part of a biopsy, they can also be used as palliative treatments to help relieve symptoms caused by mesothelioma.
Risks Associated with Needle Biopsies
Needle biopsies are tolerated well by most patients and rarely involve significant complications. The types of risks that do exist with these procedures include mild pain or discomfort during the insertion of the needle, and minor bleeding if a blood vessel is nicked during needle insertion.
In very rare instances, a biopsy needle may pierce the lung or abdominal organ, depending on the type of biopsy performed. If the hole does not heal properly it could lead to further complications, such as a collapsed lung.
Camera-Assisted Biopsy (Endoscopy)
Camera-assisted biopsies are considered “minimally invasive” procedures. While they technically qualify as surgery, they require only a small incision, into which a tube containing a camera can be inserted and a tissue sample can be removed. Unlike needle biopsies, the patient is often given general anesthesia during camera-assisted biopsies.
The main benefit of a camera-assisted biopsy is that it lets doctors visually inspect the tumor within the body, and then obtain a tissue sample that is large enough for proper analysis. As a surgical procedure, camera-assisted biopsies do contain certain risks; however, camera-assisted biopsies are still less invasive than open surgery biopsies, and recovery is relatively quick overall.
Camera-Assisted Biopsy Types
Sometimes called Video Assisted Thoracoscopic Surgery (VATS), a thoracoscopy uses a scope (thoracoscope) with a small camera to look within the chest and pleural space. A thoracoscopy will be used when pleural mesothelioma is suspected.
During the procedure, the surgeon will make several small incisions in the chest between the ribs, through which the scope is inserted. If the tumor can be seen, the doctor will take a small tissue sample for further analysis.
Laparoscopy is a procedure that uses a small scope (laparoscope) with a light and a camera to view the abdominal space. A laparoscopy will be used when peritoneal mesothelioma is suspected.
During the procedure, the surgeon will make a couple of small incisions in the stomach and inflate the abdomen with a gas, such as carbon dioxide, to provide a clear view of the abdominal organs. The laparoscope is inserted through another incision, allowing the doctor to view the peritoneal space. Upon visualizing any tumors, the doctor will obtain a tissue sample for histological analysis. The laparoscope is then removed, and the gas is released from the abdomen.
Mediastinoscopy allows doctors to view the area between the breastbone (sternum) and lungs using a special tool called a mediastinoscope. A mediastinoscopy can be used when pericardial mesothelioma is suspected, or for any type of mesothelioma that may have metastasized into the chest.
Before the procedure, an endotracheal tube is inserted through the nose or mouth to help the patient breathe. Then, the surgeon will make a small incision immediately below the neck where the mediastinoscope will be inserted. If the doctor sees a tumor or abnormal lymph nodes, a tissue sample will be obtained and sent for laboratory analysis.
Upon viewing the tumor through one of the methods described above, the doctor will take a tissue sample for further analysis. In some cases, surgical treatment may administered at the same time as the camera-assisted biopsy, in which case the procedure will require a longer stay in the hospital.
Risks Associated with Camera-Assisted Biopsies
Camera-assisted procedures are becoming more common, and in many cases they can be done on an outpatient basis. They are often less expensive than surgical biopsies, and they are effective at allowing the doctor to obtain tissue samples from various areas in the body.
The risks associated with camera-assisted biopsies are minor. There is always a risk with the administration of anesthesia, which can cause an allergic reaction, headache, or nausea. There is also a risk of infection, bleeding, injury to organs, and in extreme circumstances, organ failure. However, most individuals tolerate the procedure well, and recovery is relatively quick.
Resources Available for Mesothelioma Patients and Their Families
- More on Mesothelioma Biopsies in our Free Mesothelioma Guide
- Connect with Top Mesothelioma Doctors
- Locate the Nearest Comprehensive Cancer Center
Surgical biopsies are open procedures that are much more invasive than either needle biopsies or camera-assisted biopsies. Due to their invasive nature, doctors tend to take a more conservative approach, prescribing them only when less invasive biopsies yield inconclusive results, or when the area is hard to reach using a needle or endoscope.
The biggest advantage of surgical biopsy is access to the area from which a tissue sample needs to be taken. The tradeoff is that surgical biopsies require a general anesthesia, and they usually need much more recovery time than other types of biopsy.
Surgical Biopsy Types
A thoracotomy is an open-chest surgical procedure that can be used to obtain a biopsy. It is used for patients who are suspected of having either pleural mesothelioma (most common) or pericardial mesothelioma (least common).
During the procedure, a thoracic surgeon will make an incision in the chest wall, sometimes as much as 3 or 4 inches long. Through the incision, the surgeon evaluate the area around the lungs, heart, or other areas of the chest to which mesothelioma may have spread. Upon finding any abnormal tissue or tumor masses, the surgeon will collect a sample for analysis.
A thoracotomy is an open abdominal procedure that may be used to obtain a biopsy. It is used for patients who are suspected of having peritoneal mesothelioma.
During the procedure, a surgeon will examine the abdominal organs closely to find the source for fluid buildup. If the doctor finds any tumors or abnormal tissue, a biopsy may be performed and the sample sent to a lab for further testing and diagnosis.
In some cases, surgeons may decide to conduct an emergency surgery to remove any tumors they find during a surgical biopsy procedure. In such instances, the doctor generally will use the same incision as was created for the biopsy to perform the biopsy.
Risks Associated with Surgical Biopsy
As with all surgery involving general anesthesia, there are risks associated with the anesthesia itself, including allergic reaction, nausea, headache, and vomiting. Other risks for surgical biopsies include infection, excessive bleeding, injury to organs or blood vessels, fluid buildup, and pain. Like any major surgery, the recovery time is significant and depends on the patient’s overall health.
What Happens After the Biopsy?
The primary goal of the biopsy is to obtain enough cancerous cells to perform analysis under a microscope. This analysis is an essential part of the mesothelioma diagnosis process.
Specifically, once a tissue sample is obtained, it will be sent off to a laboratory where a pathologist will conduct histological analysis (for surgical or camera-assisted biopsies) or cytological analysis (for needle biopsies). These analyses use a series of test to identify whether mesothelioma is present, as well as help determine the cell type, prognosis, and stage of the disease.
If a mesothelioma diagnosis is determined, the doctor will share the results with you and begin developing a treatment plan.
Mesothelioma Biopsy Costs
The cost of biopsies differ greatly depending on the type of biopsy performed, with more difficult biopsies) usually costing the least. Considering that some patients may need to have multiple biopsies to confirm a mesothelioma diagnosis, the medical expenses can add up very fast.
If biopsy results show that you or a loved one do have mesothelioma, you may be able to access some financial help to pay for your medical bills, as well as other expenses related to treatment, recovery, and lost income. Find out what monetary options are available to you by contacting an expert today.Sources
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