Mesothelioma Biopsy
Currently, a tissue or fluid biopsy is the only way to ensure that a patient receives an accurate diagnosis of mesothelioma. During a biopsy, the cells are extracted from the patient's body and analyzed to determine whether or not cancer exists and to make a definitive diagnosis. If the disease is detected, a biopsy can help an oncologist at the stage of the disease, assess the prognosis of the mesothelioma patient and lay the foundation for a comprehensive treatment plan.There are three main types of biopsies: non-invasive, minimally invasive and surgical. The purpose of each type of biopsy is to collect enough tissue, fluid or cells to determine if cancer cells are present and how far the disease has progressed. In most cases, biopsies are performed following blood tests and imaging to confirm a diagnosis.
Noninvasive biopsies of mesothelioma
Non-invasive biopsies are performed using a small or large diameter hollow needle to collect a sample of fluid around organs, including the lungs, abdomen and heart. Then, a pathologist analyzes the fluid to determine if there are mesothelioma cells. These procedures can also be used as a form of palliative care to relieve pain, reduce fluid accumulation and help patients breathe better.There are three types of non-invasive mesothelioma biopsies, sometimes called fine needle aspirations, available to patients:
- Thoracentesis: the fluid is removed from the chest
- Paracentesis: the fluid is removed from the abdominal area
- Pericardiocentesis: the fluid is removed from the cardiac sac
The type of biopsy required depends largely on the location of the fluid and only requires local anesthesia to numb the skin before the procedure. Unfortunately, needle biopsies do not always allow accurate diagnosis because they can only collect small clusters of cells and tissues for testing. Patients are likely to undergo additional tests to receive a diagnosis or possibly eliminate mesothelioma.
Minimally invasive biopsies of mesothelioma
When a patient undergoes a minimally invasive biopsy, also called an endoscopic biopsy, the surgeon makes a small incision in the body to insert a camera. Using a camera, such as an endoscope, they can examine the area where the incision is made and take tissue samples for further analysis.Other procedures may also be performed during an endoscopic biopsy. For example, during a thoracoscopy, a pleurodesis can be performed. The surgical procedure suppresses pleural effusions or excess fluid in the lungs and may alleviate symptoms in patients with pleural mesothelioma.
Mesothelioma surgical biopsies
A patient becomes a candidate for a surgical biopsy when other tests have not definitively determined the presence of malignant mesothelioma. In cases where a surgical biopsy is required, the surgeon makes a large incision in the body, allowing complete access to the chest or abdominal cavity. Biopsies of this type are done under general anesthesia and the recovery time may take several weeks.Depending on where the biopsy is to be taken, different forms of surgery are recommended. A laparotomy is used to examine tumors in the abdomen and may help a specialist diagnose cases of peritoneal mesothelioma. Thoracotomies, which occur in the chest, are used to diagnose pericardial mesothelioma or pleural mesothelioma.
What happens after the biopsy?
Once the tissue or fluid sample has been taken, it is sent to a laboratory for testing to determine if mesothelioma cancer is present. A pathologist first conducts a thorough examination of the sample and records the results, and the samples are prepared for analysis. This is done by concentrating the cells in a fluid sample or by placing tissue samples on glass slides. Pathologists use cytology and histology to determine cell type and determine if mesothelioma cells are present in the sample provided.Once the tests are complete, the laboratory will retain these samples for future reference. This is important for patients seeking a second opinion or in case of cancer recurrence. According to the American Cancer Society, laboratories must keep biopsy samples for several years to remain compliant with the Federal Amendments on Clinical Laboratory Improvements (CLIA). Some states have additional laws requiring that samples be kept even longer than the mandate of the federal guidelines.
If a malignant mesothelioma is diagnosed in a patient, a specialist will develop a treatment plan tailored to the case. If the cancer is diagnosed at an early stage, patients usually have several potentially curative treatments, such as surgery. However, a late diagnosis may only provide palliative care options.