Mesothelioma Biopsy

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

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

Biopsies and diagnosis of mesothelioma

A biopsy is often the last step in a diagnosis, after imaging tests and blood tests. Biopsies are not usually prescribed until there are signs and symptoms that suggest a diagnosis of cancer because it is an invasive procedure.

If abnormalities are detected during an image analysis, patients undergo a biopsy during which a sample of tissue or fluid is taken for analysis as part of a process called pathology. The analysis will allow specialists to determine whether a tumor is malignant or benign, confirm mesothelioma and determine the type of cell (epithelioid, sarcomatoid or biphasic). Biopsy is the only way to confirm a cancer diagnosis. It is therefore crucial for determining the patient's treatment options and prognosis.

Types of mesothelioma biopsies

When diagnosed with mesothelioma, three types of biopsies are common: needle biopsies, camera-assisted biopsies, and open biopsies. The type of biopsy performed will be determined based on the type of mesothelioma.

Needle biopsies

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

Needle biopsy procedure

Common types of needle biopsy techniques include:

Fine needle aspiration. This type of needle biopsy uses a thin, hollow needle to collect cells from your body.

Basic needle biopsy. This type of needle biopsy uses a larger needle than fine needle aspiration. The needle used in a needle biopsy is a hollow tube that allows the doctor to extract a core of tissue for testing.

You may experience mild discomfort during your needle biopsy, such as a feeling of pressure in the area. Tell your healthcare team if you feel uncomfortable.

Thoracentesis

Thoracentesis is most often performed to remove fluid from the space between the lungs and the chest wall. Most often, the doctor numbs the area with a local anesthetic and then inserts the needle into the patient's back along the mid-scapular line (about halfway between the spine and the flank). Once the fluid is drained, the needle will be removed and the area will be covered with a sterile bandage.

Paracentesis

Paracentesis is performed to remove excess fluid around the abdomen. As a general rule, the area where the needle should be inserted will be shaved, cleaned and numbed with local anesthetic. The doctor will then insert a thin 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 on the syringe so that the fluid can be collected in a vacuum bottle. When enough fluid is collected, the needle will be removed and the area will be covered with a sterile bandage.

Pericardiocentesis

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 breast immediately below the sternum where the needle will be inserted. An echocardiogram is often used to help guide the placement of the needle during the procedure. After the biopsy, the needle is removed and the area is covered with a sterile bandage. In some cases, a catheter may be inserted to allow the fluid to continue to flow.

Core Needle Biopsy

A basic needle biopsy is a minimally invasive procedure that involves the use of a CT scan or ultrasound to guide a needle through the skin in a suspected tumor area, such as a thickened pleura. A piece of tissue is taken with the needle and analyzed by pathologists. After the biopsy, the needle is removed and the area is covered with a sterile bandage. This type of sample (called surgical pathology) allows pathologists to diagnose mesothelioma with greater probability than fluid analysis (called cytology).

Camera-assisted biopsies

Camera-assisted biopsies, or endoscopies, are considered "mini-invasive" procedures that allow doctors to visually inspect the tumor and obtain a sample of tissue large enough for proper analysis. Recovery is generally rapid, although there are some risks, including infection, bleeding, damage to nearby organs, or organ failure in severe cases. The risks are also associated with the administration of anesthesia, including allergic reactions, headaches and nausea.

Procedure for Camera -Assisted Biopsy

• General anesthesia is usually given to the patient.
• For insertion of a thin tube a small incision is made .
• The tube contains a camera that guides the removal request of a tissue sample.
• Some endoscopies take pictures during the procedure for later examination.
• Blood Presssure, Heart rate and Temperature are measured throughout the procedure.
• Patients often go to the recovery room for a short time and must be brought home after receiving anesthesia.

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

Thoracoscopy

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

Laparoscopy

Laparoscopy is the most used when there is suspicion of peritoneal mesothelioma. 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 telescope (laparoscope) is inserted with a light and a camera to locate the tumors and take a tissue sample for analysis. Once the sample is taken, the oscilloscope will be removed and the gas will be released from the abdomen.

Mediastinoscopy

Mediastinoscopy is common in case of suspicion of pericardial mesothelioma or in the presence of thoracic metastases. A mediastinoscope is used to examine the mediastinum, or the space between the sternum and the middle of the chest, between the lungs. First, an endotracheal tube is inserted into the patient's nose or mouth to facilitate breathing. An incision is then made under the neck to insert the telescope allowing the surgeon to locate the tumor or abnormal lymph nodes and to take a tissue sample for analysis.

Surgical Biopsies

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

The benefit of collecting a mesothelioma biopsy through surgery is access to getting a large sample of tissue, although there are risks such as infection, bleeding, organ or vessel injury blood, fluid accumulation and pain, as well as allergic reactions, nausea, headache and vomiting in response to anesthesia.

Surgical Biopsy Procedure

• General anesthesia is usually administered.
• A surgical incision is made in the affected area to access the tumor.
• A sample of the affected tissue is removed.
• The surgical treatment is administered and the patients go to a recovery room.
• After the procedure, short stay in the hospital may be necessary .

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

Thoracotomy

A thoracotomy is an open-chest procedure that allows doctors to access the chest cavity for 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 assess areas around the lungs, heart, or other affected areas where metastases are suspected. When abnormal tissues or tumor masses are found, samples are taken for analysis.

Laparotomy

A laparotomy is an open abdominal procedure commonly used to obtain a biopsy if there is suspicion of peritoneal mesothelioma or peritoneal effusion (fluid accumulation). 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 take a sample for analysis to confirm the diagnosis.

In some cases, surgeons may decide to proceed with an emergency surgery to remove any tumors they find during a surgical biopsy procedure. In such cases, the doctor will usually use the same incision.

Diagnosis after a biopsy

The only way to definitively diagnose mesothelioma is a biopsy. When a biopsy is taken, it is sent for pathological analysis. These results will confirm malignancy, type of cancer, cell type and staging, while helping specialists provide patients with treatment options and prognosis.

Which Biopsy Is Right For You?

When mesothelioma is suspected, the type of biopsy that patients undergo depends on imaging tests, blood tests and their doctor. The location of the tumor is also an important factor. Patients with peritoneal mesothelioma, for example, tend to undergo fine needle aspiration because some parts of the peritoneum may be difficult to reach surgically. Thoracoscopic surgeries are the most common biopsy for pleural patients.

The consultation of a specialist is crucial for patients suspected of mesothelioma. Doctors experienced in the recognition of mesothelioma in pathology and cytology reports are essential because a misdiagnosis is too common with this disease.