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Diagnosing mesothelioma begins with your first visit to the doctor after you notice symptoms. Typically, the process begins with a routine physical exam and a discussion of medical history with a general practitioner. The next steps include imaging the lungs and pleura to look for potential tumors. Imaging is usually followed by biopsies to confirm the presence of tumors and cancer cells.
A biopsy is an important step, not only in diagnosing mesothelioma, but also in staging it. When biopsy cells are examined, a diagnostician may be able to determine not only if the cells are cancerous, but also what type of cancer is present. Though diagnosing mesothelioma is difficult and often results in misdiagnoses, a biopsy is the best technique available for developing treatment plans.
What is a Biopsy?
A biopsy is the examination of a fluid or tissue sample for the purpose of diagnosing a condition. Medical professionals also use biopsies to find the source of an illness and determine its extent. A cancer biopsy can confirm the presence of cancerous cells, reveal the types of cancer cells, and show how if and far the cancer has spread.
A tissue or fluid sample is extracted with a needle, with open surgery, or with an endoscope. A pathologist examines the samples under a microscope to learn about the tissue, cells, and fluid.
The Importance of Biopsies in Diagnosis
A biopsy is one part of a complete diagnosis for mesothelioma. It is the most accurate way to confirm someone actually has mesothelioma. An imaging test can tell a doctor that there is some type of tumor in the pleura or other area of the body. However, imaging cannot confirm suspected tissues are malignant or determine the specific type of cancer. Biopsies also determine the extent of the cancer. All of this information helps the patient and medical team develop the best possible treatment plan.
Blind vs. Guided Biopsies
Mesothelioma patients may have two types of biopsy. A blind biopsy is taken without knowing exactly where the suspected tumor or cancerous tissues are located. A guided biopsy uses an imaging technique like a CT scan to target the location of the tissue in question. Guided biopsies are more accurate in making mesothelioma diagnoses. Specifically, biopsies guided specifically by CT scans provide the most accurate diagnoses.
Fluid and Needle Biopsies
Testing fluid that builds up during mesothelioma can be a useful part of the diagnosis. When pleural mesothelioma is suspected, fluid is taken from the chest for testing. This procedure is called a thoracentesis. A paracentesis removes fluid from the abdomen to test for peritoneal mesothelioma. A pericardiocentesis removes fluid from the sac around the heart to test for pericardial mesothelioma.
A fluid biopsy is not invasive. This procedure can typically be performed in a doctor’s office with local anesthetic. A small needle is inserted through the skin to the area of fluid buildup. Then a small amount of fluid is removed for testing. The fluid is examined under a microscope to look for cancer cells. In addition to fluid, a tissue sample may also be taken.
An endoscope is a thin, flexible tube used to examine inside the body. The endoscope has a light as well as a lens or a camera that allows the doctor to see deep into the body. This procedure is relatively noninvasive and does not require a large incision or open surgery.
Because most cases of mesothelioma are pleural, biopsies for mesothelioma are typically thoracoscopies. A thoracoscopy is a type of endoscopy. The endoscope is inserted into the chest to examine the pleura and suspected tumors. DUring the procedure, a biopsy sample will be removed for further study. Although less invasive than open surgery, an endoscope biopsy like this still requires the patient be under general anesthesia.
Less invasive and lower risk techniques for biopsies are always used first. However, sometimes they are not enough to diagnose mesothelioma. As a last resort, doctors will conduct open surgery. Open surgery uses a large incision to remove a significant amount of tissues. A thoracotomy involves an incision in the chest to remove part of a tumor or an entire tumor. A laparotomy is the same procedure through the abdomen and is used for diagnosing peritoneal mesothelioma.
Incisional and Excisional Biopsies
Biopsies for mesothelioma are also sometimes classified as incisional or excisional. For an incisional biopsy, only a small amount of tissue is removed from a tumor. These are done when the tumor is easily accessible. An excisional biopsy refers to the entire removal of a tumor. If possible, doctors will remove an entire mass, both for testing and as a part of treatment. This procedure is like killing two birds with one stone. It allows for a biopsy of the tumor and negates the need for later surgical removal.
There are many types of biopsies. The type you may undergo for mesothelioma diagnosis depends on individual factors. Your medical team will decide which biopsies are necessary for accurate diagnosis. From there they will set you on a path to treatment.
Page Edited by Patient Advocate Dave Foster
Dave has been a mesothelioma Patient Advocate for over 10 years. He consistently attends all major national and international mesothelioma meetings. In doing so, he is able to stay on top of the latest treatments, clinical trials, and research results. He also personally meets with mesothelioma patients and their families and connects them with the best medical specialists and legal representatives available.