Biopsy Procedures

X-Rays, CT Scans. MRI scans and PET scans can offer a fair diagnosis. However to arrive at a definitive conclusion a physician often recommends a biopsy. A biopsy is a surgical procedure where a sample of tissue or fluid is obtained from the affected area and it is then examined in a laboratory by a pathologist. The sample is then analyzed under a microscope and a definitive conclusion may be reached whether the individual has mesothelioma or not. A biopsy may also determine the type of cells of the mesothelioma, so that the appropriate treatment plan may be determined. The physician selects the adequate biopsy procedure depending on the area affected.


Needle Biopsy
If the patient has accumulation of fluids in the chest (pleural effusion), a long hollow needle can be inserted into the chest cavity and a sample of this fluid is aspirated. The same procedure can be done if the patient has accumulation of fluid in the abdomen or in the heart area. Such fluid is then analyzed in the laboratory in order to determine if cancer cells are present. If this is the case, other tests need to be done in order to determine if the cancer is mesothelioma or another type of cancer. However this procedure often leads to inconclusive results and many physicians would like to take also a tissue sample.
In order to take a tissue sample, a needle is inserted into the chest cavity and is then rotated. Tissue samples are collected as the needle is taken out. However such procedure may be dangerous since there is the chance of tumor seeding along the needle tract and so radiation therapy may need to be applied after the test. Because the tissue taken is usually small, this method has a limited reliability.


Thoroscopy
A tissue sample can be obtained by a new technique called thoroscopy. In this procedure a thoroscope (an instrument similar to a telescope with a video camera) is inserted from a small incision in the patient’s chest. The physican can see the tumor through the thoroscope. With the aid of special forecep, a sample of the tumor can then be removed. This technique is usually done under a local anesthesia and is usually performed in the case of pleural mesothelioma and pericardial mesothelioma.


Laparoscopy
In the case of peritoneal mesothelioma a laparoscopy is performed in order to obtain a sample of this tumor. A laparoscopy is similar to thoroscopy but the procedure is performed in the abdominal cavity instead of the chest. In a laparoscopy a laparoscope is inserted into the abdominal cavity through a small cut. The physician can so look inside the patient’s body and can take samples of abnormal tissues. This procedure is usually done under a general anesthetic and more than one incision can be performed. Fluid samples can be also taken during laparoscopy and thoroscopy.


Thoracotomy
This is a surgical procedure to open the chest cavity and to check for signs of tumors. A large sample tissue is taken in order to be tested in the laboratory. Sometimes the tumor is removed in this procedure.


Laparotomy
This is a surgical procedure to open the abdominal cavity and to check for signs of tumors. A large sample tissue is taken in order to be tested in the laboratory. Sometimes the tumor is removed in this procedure.


VATS (Video-Assisted Thoracoscopic Surgery)
In this procedure several small cuts are made in the chest wall. A camera and the required surgical instruments can be inserted in different cuts in order to collect tissue samples. The surgeon can look at a video screen showing the images of the camera.


Mediastinoscopy
In this procedure a very small incision is made above the breast bone and a tube is inserted and moved down into the chest. A physician can look at the lymph nodes through the tube. Lymph Nodes are part of the body’s immune system and their function is to collect and destroy bacteria and viruses. When the body is fighting an infection or cancer, the lymph nodes are usually swollen. By looking at the lymph nodes the physician will get information regarding the type and spread of the cancer. By analyzing the tissue samples taken, the pathologist can determine if the tumor is mesothelioma cancer or another type of cancer.


Peritoneoscopy
This procedure can be performed in the case of peritoneal mesothelioma, where the physician can look inside the abdomen with a peritonescope through a cut made in the abdomen. If fluid has accumulated in the abdomen it should be first removed.


Bronchoscopy
This procedure can be used if the patient is suspected to have pleural mesothelioma. A flexible tube (bronchoscope) is inserted into the bronchi through the patient’s mouth in order to see any masses in the airway. The physician can see into the airways through an eyepiece. The physician may take abnormal-looking samples of tissue for analysis.