To determine if a cancer is mesothelioma, the doctor will usually order a biopsy. During the biopsy, a surgeon extracts a small sample of tumor tissue or flue to be analyzed by a pathologist. While X-rays and blood tests can be effective to diagnose mesothelioma, a biopsy is the most effective way to ensure an accurate diagnosis. (asbestos.com)
Why a Biopsy?
Biopsies are done to determine whether the tumor is cancerous. It also can be helpful when trying to figure out which type of cancer it is. When the tumor cells are removed with the biopsy, the pathologist will view the sample with a microscope. The pathologist will analyze the activity, features, and interactions of the cells to confirm if it is cancer and which type. (Cancer.org)
Imaging scans and blood tests are improving to diagnose mesothelioma, but the biopsy is still the best way to diagnose various forms of mesothelioma. It is easy for a doctor to mistake mesothelioma for many benign illnesses because of early mesothelioma symptoms that can mimic a cold or flu. Doctors also can mistake mesothelioma for a different type of cancer.
Facts About a Mesothelioma Biopsy
- Surgically removes possible cancer cells for analysis by a pathologist
- It is necessary to get a completely accurate mesothelioma diagnosis
- The most common type of biopsy is the video-assisted thoracoscopic surgery
- There are other types of biopsy that extract fluid or tissue via a needle
A biopsy is important to diagnose mesothelioma because there are three major cell types that have different prognoses. The progression of mesothelioma is divided into four stages based on how far it has spread. Only a complete biopsy that is done by an experienced surgeon and pathologist can give the patient an accurate diagnosis.
There are various types of biopsy, depending on how invasive the method is, and whether local or general anesthesia is needed. The location and type of the patient’s tumor also are decisive in which procedure is performed.
Patients who may have peritoneal mesothelioma usually have a fine-needle aspiration biopsy. Video-assisted thoracoscopic surgery is most effective for patients who may have pleural mesothelioma.
Video-Assisted Thoracoscopic Surgery (VATS)
This type of biopsy is an endoscopic procedure. This means the surgeon inserts a thin, tub-shaped instrument with a small camera and light at the end to view inside the body without the need to make a large incision. This instrument is known as an endoscope. It could have a tool that extracts tissue samples, or the surgeon may use it in addition to other surgical tools to remove the sample. (clevelandclinic.org)
This procedure needs general anesthesia, but it is a less invasive form of surgery. It has low recovery time and minor risk of complications.
Endoscopic procedures go by different names depending on where they are done in the body:
- Thoracoscopy: Looks into the chest cavity
- Laparoscopy: Looks into the abdominal cavity
- Mediastinoscopy: Looks at the area between the lungs
Thoracoscopic biopsy has an excellent record of accurately diagnosing pleural mesothelioma; it allows doctors to view the pleural space to see if cancer has spread. This technique also allows doctors to remove several samples.
In a clinical study in 2008 of 45 mesothelioma patients, scientists looked at the accuracy of severy type of biopsy techniques. Thoracoscopy was related to the highest degree of diagnostic accuracy. The diagnosis was confirmed in 95% of the patient.
Physicians may also use a thoracoscopy with a pleurodesis operation. This is a specific intervention that involves inserting a slightly irritating medication into the pleural space. This is the space between the lung and the chest wall.
The reason for this procedure is to try to stick the lung to the chest wall so fluid or air will not collect in this space. The idea is to stop malignant fluid from accumulating around the lungs and making it difficult for the patient to breathe. A pleurodesis procedure is often effective in about 50% of cases to prevent malignant effusion.
Different Biopsy Options for Mesothelioma
Most mesothelioma doctors use thoracoscopy for most patients, the procedure is not always possible because of the location of the tumor. Other procedures that are used to diagnose mesothelioma involve draining fluid from around the lungs, taking out cells through a needle, or doing a surgery that removes tumors.
Draining Buildup of Fluid
Thoracentesis involves the use of a hollow needle to pull fluid from the pleural lining surrounding the lungs. Doctors often do this to remove fluid that makes it hard for the patient to breathe, but the fluid also can be helpful to diagnose cancer.
The operation also takes out cancerous fluid from space around the lungs. The surgeon usually can relieve some of the disease’s painful symptoms, reduce problems with shortness of breath and obtain fluid for further analysis. Some doctors will do pleurodesis at the same time they do the thoracentesis.
Needle Biopsies
Fine needle aspiration or FNA is a safe, fast biopsy that features a hollow, long needle coupled to a syringe to remove up to 10,000 sample cells. This operation is often preferred by specialists because it is easier to reach difficult areas, such as lymph nodes between the lungs. This can be done with FNA without having to put the patient under general anesthesia.
A wider needle may be needed to collect more sample cells, which is common when the tumor is accessible. Needle biopsies may be guided by ultrasound imaging, and local anesthesia is usually only required.
Even with larger samples, needle biopsies are not as effective to diagnose mesothelioma s thoracoscopic surgery. The diagnostic sensitivity of this technique is approximately 80%
Surgery to Remove Tumor
In a surgical resection, surgeons attempt to take out as much of cancer as possible. The procedure offers the largest amount of tissue for analysis. It also can eliminate the need for follow-up surgery if tests prove the tumor is malignant.
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