To reach a conclusive diagnosis, a doctor must confirm that any cells in question are actually mesothelioma. One of the most definitive ways to gain confirmation and ensure an accurate diagnosis is to perform a biopsy. Biopsies are considered the most important part of the mesothelioma diagnostic process.
Simply put, a biopsy is the removal of tissue or fluid samples and the follow-up analysis of what was removed. The removed sample, under a microscope, can reveal the presence of cancer, the activity and interaction of cells as well as the type and amount of cancer. It can also reveal that there is no mesothelioma.
There are a number of biopsy procedures for doctors to choose from and the location and type of mesothelioma involved will dictate which biopsy should be used. For example, peritoneal mesothelioma patients may undergo a fine-needle aspiration biopsy while pleural mesothelioma patients are more likely to undergo a thoracoscopic biopsy. The thoracoscopic biopsy has earned a reputation among medical professionals as being the most effective biopsy for pleural mesothelioma. Because 75 percent of mesothelioma cases are pleural, the majority of mesothelioma patients undergo a thoracoscopic biopsy.
Thoracoscopy
A thoracoscopy has shown very accurate results in diagnosing mesothelioma. This procedure, also known as open pleural biopsy, allows inspection of the pleural space and multiple biopsies under direct vision. Several studies have reported that when a thoracoscopy is used an accurate diagnosis can be achieved in up to 98 percent of mesothelioma patients. This direct examination of the pleura may also help in staging the cancer and determining prognosis.
A 2008 study of 45 malignant mesothelioma patients found that an open pleural biopsy provided an accurate diagnosis with sensitivity (amount of true positives) of 95 percent and specificity (amount of true negatives) of 100 percent. CT-guided pleural biopsies were accurate in 100 percent of cases.
A 2011 study performed by the Imperial College of London confirmed that the high specificity and sensitivity rates of an open pleural biopsy make it the preferred diagnostic technique for malignant pleural mesothelioma. Other, less accurate biopsies may use long needles to extract tissues samples.
Additional Biopsies for Diagnosing Mesothelioma
Although a thoracoscopy yields superior results in comparison to other biopsies, this procedure is not always possible due to specific tumor location and other complications. Additional biopsies that can be used to diagnose mesothelioma include:
Fine-Needle Aspiration (FNA) Biopsy - A quick and safe procedure, FNA biopsies use a long, hollow needle to remove up to 10,000 sample cells for testing. This procedure is preferred for its ability to access hard-to-reach areas without requiring anesthesia. FNA biopsies of a pleural or peritoneal effusion can diagnose mesothelioma with an accuracy of up to 84 percent.
Thoracentesis - This procedure extracts fluid from the lungs and pleura using a hollow needle. The fluid is then analyzed to determine if any disease is present.
Thoracotomy - A thoracotomy is a type of surgery used to access the lungs, heart, aorta, diaphragm and trachea. For mesothelioma patients, a segmentectomy, also known as a wedge resection, is the preferred type of thoracotomy since it leaves most of the affected lung intact. During the surgery, a wedge-shaped piece of the lung is removed for examination.
Endoscopic Biopsy - An endoscopic biopsy is one of the most commonly used forms of biopsy. This procedure involves a fiber optic endoscope that shows the surgeon the area being sampled. Small forceps attached to the endoscope are used to remove small slivers of tissue from the tumor in question.
Excisional Biopsy - During an excisional biopsy, the entire tumor or organ is removed for diagnosis. This can eliminate the need for a second surgery to remove the tumor if testing shows it is malignant.
Incisional (Core) Biopsy - During an incisional biopsy, only a small section of suspicious tissue is removed. This is a common procedure when the tissue sample is easy to collect. Unfortunately, mesothelioma tumors typically do not develop at an easy-to-reach location.
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