Mesothelioma Biopsy

Expert Fact Checked

This page was medically reviewed by James Stevenson, M.D. on March 10, 2019. For information on our content creation and review process read our editorial guidelines. If you notice an error or have comments or questions on our content please contact us.

James Stevenson, M.D. Thoracic Medical Oncologist

A mesothelioma biopsy removes a sample of tissue or fluid to determine if it is cancerous. Biopsies are the only way to confirm a patient has malignant mesothelioma. Analysis of a biopsy sample can help doctors determine the best treatment options.

01. What Is a Biopsy?

What Is a Biopsy?

A biopsy is a medical procedure that collects a tissue or fluid sample from a patient. After the sample is collected, it is sent for analysis by a pathologist.

Analysis will allow doctors to determine whether a tumor is malignant or benign. A biopsy is the last procedure necessary to diagnose cancer. However, doctors may conduct further testing to rule out additional concerns.

Doctors may not order a biopsy until a patient shows signs and symptoms of cancer. If abnormalities are found during an imaging scan, patients could undergo a biopsy.

Biopsy procedures can range from minimally invasive to highly invasive depending on the specific type of biopsy.

A Biopsy Helps Doctors Diagnose Mesothelioma

A mesothelioma biopsy is the only definitive way to confirm a mesothelioma diagnosis. After a biopsy, testing of the sample can confirm a patient has mesothelioma.

Biopsy analysis can determine cell type (epithelioid, sarcomatoid or biphasic). It also may inform mesothelioma stage with the help of imaging studies.

Accurate diagnosis and staging help doctors understand the best mesothelioma treatment options for each individual case. It also enables patients to 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 signal mesothelioma type.

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

Needle Biopsies

Needle biopsies are considered minimally invasive procedures. They are usually quick with little to no recovery time.

Needle Biopsy Procedure

  • Physicians use a small- or large-bore needle to extract fluid from the area around the tumor site that may contain cancer cells.
  • Patients are typically awake during the procedure.
  • Physicians may use ultrasounds or CT cameras to help guide needle placement.
  • If a patient presents symptoms and the needle biopsy results are inconclusive, a surgical biopsy may follow.

A core needle biopsy is one type of needle biopsy used to extract a piece of tissue from the tumor site. Needle biopsies may also be used to collect tissue samples from the lymph nodes to determine cancer metastasis (spread).

  • Core needle biopsy: A minimally invasive procedure that involves the use of a CT scan or ultrasound to guide a needle through the skin to a tumor site. A piece of tissue is removed with the needle and then analyzed by pathologists.

Some needle biopsies are also called fluid biopsies because they drain and test fluid around the tumor site. Fluid biopsies are also useful as a palliative treatment. The biopsy can help relieve fluid buildup and pressure around the organs. This can alleviate symptoms.

Fluid biopsies are less likely to provide enough information for a definitive mesothelioma diagnosis than a tissue biopsy.

Camera-Assisted Biopsies

Camera-assisted biopsies allow doctors to inspect the tumor and obtain a tissue sample large enough for proper analysis. Camera-assisted biopsies are also called endoscopic biopsies.

Camera-Assisted Biopsy Procedure

  • General anesthesia is given to the patient.
  • A small incision is made and a thin tube is inserted.
  • 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.
  • 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.

There are several types of camera-assisted biopsies. A doctor will determine which biopsy to use based on the location of the tumor site. Common types of camera-assisted mesothelioma biopsies include thoracoscopy, laparoscopy and mediastinoscopy.

  • Thoracoscopy: Using a camera called a thoracoscope, doctors can visualize the tissue inside the chest and take tissue samples. A thoracoscopy can provide an adequate tissue sample for diagnosing pleural mesothelioma.
  • Laparoscopy: Using a camera called a laparoscope, doctors can locate tumors in the abdominal cavity and remove a tissue sample for analysis. A laparoscopy may be recommended for obtaining a peritoneal mesothelioma sample.
  • Mediastinoscopy: A mediastinoscope is used to look at the mediastinum, or, the space between the sternum and middle of the chest. A mediastinoscopy may be performed if pericardial mesothelioma is suspected or if the cancer has spread to the chest.

Surgical Biopsies

Doctors may perform surgical biopsies when less-invasive procedures are inconclusive. A surgical biopsy may also be used if the suspected tumor cannot be easily reached with a needle or an endoscope.

A surgical biopsy may be beneficial for obtaining a large tissue sample.

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.
  • After surgery, patients go to a recovery room.
  • A short hospital stay may be required after the procedure.

Surgical biopsies used to diagnose mesothelioma are a thoracotomy and a laparotomy.

  • Thoracotomy: Doctors will create a large incision in the chest cavity. This allows the physician to directly view tissues and gather biopsy samples. This procedure is done under general anesthesia.
  • Laparotomy: Doctors will create a large incision in the abdomen. This allows the physician to directly view tissues and gather biopsy samples. This procedure is done under general anesthesia.

In some cases, surgeons may decide to conduct an emergency surgery during a surgical biopsy. In these cases, a surgeon may remove some of the cancerous tissue.

03. 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, but it 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 a sample from the tumor site is collected, it is sent for pathological analysis. The patient’s physician will review the results and communicate them with the patient.

Mesothelioma doctors will also use biopsy information to understand a patient’s prognosis and develop a treatment plan. Mesothelioma patients may begin treatment right away.