Mesothelioma.com Resources for Patients and their Families

Mesothelioma Biopsy

Biopsies are the last step in a mesothelioma diagnosis and the only way to confirm that a patient has the cancer. The most common types of biopsies used are needle biopsies, camera-assisted biopsies and surgical biopsies, each with varying degrees of invasiveness.

Mesothelioma biopsies are meant to remove a sample of affected tissue or fluid for analysis, to then confirm malignancy, mesothelioma type, cell type (epithelioid, sarcomatoid or biphasic) and staging. This step in the diagnostic process will help determine viable treatments and provide a more accurate prognosis for the patient.

Diagnostic Methods

Biopsies and Diagnosing Mesothelioma

A biopsy is typically the last stage of a diagnosis, after imaging tests and bloodwork. Biopsies typically aren’t ordered until there are signs and symptoms that point toward a cancer diagnosis, since they are an invasive procedure.

If abnormalities are found during an image scan, patients will undergo a biopsy, where a tissue or fluid sample is collected for analysis in a process called pathology. The analysis will allow specialists to determine whether a tumor is malignant or benign, confirm mesothelioma and determine cell type (epithelioid, sarcomatoid or biphasic). A biopsy is the only way to confirm a cancer diagnosis, and is therefore crucial in determining a patient’s treatment options and prognosis.

Types of Mesothelioma Biopsies

There are three types of biopsies that are common during a mesothelioma diagnosis, including needle biopsies, camera-assisted biopsies and open surgery biopsies. The type of biopsy that is performed will be determined based on mesothelioma type.

Needle Biopsies

Needle biopsies are considered closed (non-surgical) procedures that are usually quick with little to no recovery time. Like any procedure, there are risks involved, including mild pain and discomfort, bleeding or damage to nearby organs, depending on needle biopsy type and location.

Needle Biopsy Procedure
  • A small- or large-bore needle is used to extract fluid containing cancer cells from the area around the tumor.
  • Patients are typically awake during the procedure.
  • Ultrasounds or CT cameras may be used to help guide needle placement.
  • A surgical biopsy may follow if a patient presents signs and symptoms of mesothelioma, but the needle biopsy doesn’t show the cancer.

There are three main types of needle biopsies that differ based on location. Designed to remove fluid from the affected area, these biopsy types are also used as palliative treatments to relieve pressure and reduce symptoms of pleural, peritoneal and pericardial effusion.

Thoracentesis

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 into 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.

Paracentesis

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.

Pericardiocentesis

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.

Camera-Assisted Biopsies

Camera-assisted biopsies, or endoscopies, are considered “minimally invasive” procedures that allow doctors to visually inspect the tumor and obtain a tissue sample large enough for proper analysis. Recovery is typically quick, though there are some risks involved, including infection, bleeding, injury to nearby organs or organ failure in severe cases. Risks are also associated with anesthesia administration including allergic reactions, headaches and nausea.

Camera-Assisted Biopsy Procedure
  • General anesthesia is usually given to the patient.
  • A small incision is made for insertion of a thin tube.
  • The tube contains a camera that guides application for removal of a tissue sample.
  • Some endoscopies take images during the procedure for later review.
  • Temperature, blood pressure and heart rate are measured throughout the procedure.
  • Patients often go to a recovery room for a short period of time and must be driven home after receiving anesthesia.

Like needle biopsies, there are several different types of camera-assisted biopsies, depending on location. For mesothelioma, the most common types include thoracoscopy, laparoscopy and mediastinoscopy.

Thoracoscopy

After anesthesia is administered, the surgeon will make several small incisions in the chest and between the ribs to access the pleural cavity or thoracic cavity. The scope is inserted and if the tumor is seen, a small tissue sample is removed for analysis.

Laparoscopy

Laparoscopy is most commonly used when peritoneal mesothelioma is suspected. Small incisions are made in the stomach and the abdomen is inflated with gas (usually carbon dioxide) to access the peritoneal cavity and get a clear view of the abdominal organs. A small scope (laparoscope) is inserted with a light and camera to locate tumors and remove a tissue sample for analysis. Once the sample is taken, the scope will be removed and the gas is released from the abdomen.

Mediastinoscopy

A mediastinoscopy is common when pericardial mesothelioma is suspected or when metastasis to the chest is present. A mediastinoscope is used to look at the mediastinum, or the space between the sternum and middle of the chest, between the lungs. First, an endotracheal tube is inserted into the patient’s nose or mouth to assist with breathing. An incision is then made below the neck for insertion of the scope for the surgeon to locate the tumor or abnormal lymph nodes and remove a tissue sample for analysis.

Surgical Biopsies

Surgical biopsies differ from needle and camera-assisted types in that they are much more invasive. Doctors are conservative when ordering surgical biopsies, only prescribing them when results of less-invasive procedures are inconclusive or when the area cannot be reached easily with a needle or endoscope.

The benefit of collecting a mesothelioma biopsy through surgery is access for obtaining a large tissue sample, though there are risks involved such as infection, bleeding, injury to organs or blood vessels, fluid buildup and pain, as well as allergic reactions, nausea, headaches and vomiting as reactions to anesthesia.

Surgical Biopsy Procedure
  • General anesthesia is typically administered.
  • A surgical incision is made at the affected area to access the tumor.
  • A sample of the affected tissue is removed.
  • Surgical treatment is administered and patients go to a recovery room.
  • A short hospital stay may be required after the procedure.

Surgical biopsies require the longest amount of recovery time, but recovery and side effects may differ based on patient age, overall health and what type of surgical biopsy was performed. The most common surgical biopsies for mesothelioma include a thoracotomy and laparotomy.

Thoracotomy

A thoracotomy is an open-chest procedure that gives doctors access to the thoracic cavity to obtain a biopsy. This is most commonly used for pleural mesothelioma, but has also been used for cases of pericardial mesothelioma. During the procedure, a thoracic surgeon will make an incision in the chest wall to then evaluate areas around the lungs, heart or other affected areas where metastasis is suspected. When abnormal tissues or tumor masses are found, samples are collected for analysis.

Laparotomy

A laparotomy is an open abdominal procedure commonly used to obtain a biopsy when peritoneal mesothelioma is suspected or peritoneal effusion (fluid buildup) is found. During the procedure, a surgeon will closely examine the abdominal organs to identify tumors, abnormal tissues or causes of effusion. If found, a biopsy is performed to remove a sample for analysis to confirm 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.

Resources Available for Mesothelioma Patients and Their Families

Diagnosis After a Biopsy

The only way to definitively diagnose mesothelioma is with a biopsy. When a biopsy is collected, it’s sent for pathological analysis. Both histology and cytology analyses are covered during pathology, determining and understanding cell type, while also looking deeper into how the cells are forming, dividing and behaving. These findings will confirm malignancy, cancer type, cell type and staging, while also helping specialists to provide patients with treatment options and a prognosis.

Author: Linda Molinari

Editor in Chief, Mesothelioma Cancer Alliance

Linda Molinari

Reviewer: Annette Charlevois

Patient Support Coordinator

Annette Charlevois
Share
Tweet
Share
Sources

American Cancer Society. Types of biopsies used to look for cancer. Updated July 2015.

Hadjiliadis D. Pleural needle biopsy. MedlinePLUS. Updated October 2018.

Heffner JE. Pleural Fluid Analysis, Thoracentesis, Biopsy, and Chest Tube. Medical University of South Carolina. 2006.

Kato NS. Lung surgery. MedlinePLUS. Updated October 2018.

Kato NS. Mediastinoscopy with biopsy. Updated October 2018.

Kitabjian L, Bordi S, Elisha S, et al. Anesthesia Case Management for Video-Assisted Thoracoscopic Surgery. AANA Journal. February 2013;81(1):65-72.

Lehrer JK. Abdominal tap. MedlinePLUS. Updated June 2, 2014. Accessed on September 15, 2016.

American Thoracic Society. Management of Malignant Pleural Effusions. American Journal of Respiratory and Critical Care Medicine. March 2000;162:1987-2001. doi: 10.1164/ajrccm.162.5.ats8-00

Pass HI, Dingell JA, Vento S. 100 Questions & Answers About Mesothelioma. Burlington, MA: Jones and Bartlett; 2005.

Mesothelioma Treatment Guide

Free Mesothelioma Treatment Guide

Please fill in the form below to request our FREE Mesothelioma Treatment Guide. It will be sent to you within 24 hours.

Have you or someone you know been diagnosed with mesothelioma?

Get Access To: