Mesothelioma biopsies are crucial to mesothelioma diagnosis. Biopsies are procedures that remove cancerous cells from your tumor or fluid from the surrounding area. A pathologist then examines these cells under a microscope to determine if you have cancer, and if so, what type.
Mesothelioma biopsies can determine which of the three mesothelioma cell types (epithelioid, sarcomatoid, and biphasic) are present in your tumor. This information could help your doctor determine the best course of treatment for your mesothelioma cancer. Epithelioid cells are the most common; sarcomatoid are more aggressive. Biphasic tumors include both epithelioid and sarcomatoid cells.
There are several different types of mesothelioma biopsies. Your doctor might want you to get more than one biopsy over the course of your treatment. If you enroll in a mesothelioma clinical trial, the researchers will probably want to examine a sample from your tumor; this could require an additional biopsy, or you may be able to submit cells from a previous test.
Most mesothelioma biopsies are outpatient procedures with a very low risk of complications. Even so, it can be nerve-wracking to have an invasive procedure at a doctor’s office or hospital. The more you know about how mesothelioma biopsies are performed, the more at ease you can be when your doctor orders a biopsy.
Fine Needle Aspirations
Fine needle aspirations are mesothelioma biopsies performed with a long, thin, hollow needle. The needle is inserted into the tumor and removes a small sample of cells for examination.
Many mesothelioma cancers cause fluid to build up in the lining around your lungs or other organs (this lining is called the mesothelium and gives the cancer its name). Needle biopsies may draw out this fluid, which can contain cancer cells.
Fine needle aspirations are sometimes used to draw out the fluid buildup and relieve the pressure this can put on your chest or abdomen. In this case, the procedure would be therapeutic rather than diagnostic.
What to Expect During Fine Needle Aspiration
Before most mesothelioma biopsies, you will be asked to stop taking aspirin and certain other medications one week ahead of time. You may need to refrain from eating for a few hours before the fine needle aspiration.
Many people are nervous around needles. If the biopsy makes you anxious, ask your doctor for medication to help you remain calm throughout the procedure.
The medical technician will disinfect your skin before the procedure and you may receive a local anesthetic, depending on where the needle will be inserted. After the biopsy, you will need to keep the site clean and disinfected while your skin heals, to prevent infection.
Incisional Mesothelioma Biopsies
Needle biopsies are a common first step in a mesothelioma diagnosis, but they are rarely the last. Particularly if the fine needle aspiration removes only fluid, the pathologist might not have enough cancer cells to determine whether or not you have mesothelioma.
The next step is an incisional biopsy. Incisional mesothelioma biopsies remove a tissue sample from your tumor. As the name suggests, they require a small incision and are usually performed by a surgeon.
Fine needle aspirations use cytopathology or the study of cells to diagnose your cancer. Surgical mesothelioma biopsies such as the incisional biopsy use histopathology, or the study of whole tissues, to gather information.
What to Expect During an Incisional Mesothelioma Biopsy
Incisional mesothelioma biopsies are usually outpatient procedures under local anesthetic. You are likely to be sedated during the procedure. As with fine need aspiration, you will probably need to stop eating a few hours before and stop taking certain medications, especially blood thinners, ahead of time. Your doctor will provide you with detailed instructions.
If your surgeon can’t determine where your tumor is by feeling the area around it, you may need an ultrasound or other type of scan to determine the precise location for the incision. Once the surgeon locates your tumor, he will make an incision and remove a tissue sample.
Plan on recovery time after the biopsy, particularly if you were under sedation, and arrange to have someone to drive you home. Keep the incision clean and dry after the procedure, to prevent infection.
Once a pathologist has examined the tissue sample in the lab, your doctor will discuss the results with you. Surgical mesothelioma biopsies like this procedure are often the clearest diagnostic test for this rare form of cancer.
Excisional Mesothelioma Biopsies
In some cases, it makes more sense to remove your entire tumor at the time of the biopsy. These mesothelioma biopsies are called excisional.
During an excisional biopsy, the surgeon will remove the whole tumor plus some of the surrounding tissue. The normal tissue removed is called the margin. A pathologist will examine the margin to determine whether cancerous cells have migrated out from the tumor into or beyond the surrounding healthy tissue. This gives your medical team a clue about the spread and stage of your cancer.
What to Expect During an Excisional Mesothelioma Biopsy
Preparations and precautions are much the same as for incisional mesothelioma biopsies. The procedure could involve a larger incision and may require general anesthesia, so plan for a longer recovery time than for an excisional biopsy.
Endoscopic Mesothelioma Biopsies
In endoscopy, your doctor inserts a small tube or tubes near your mesothelioma tumor. A camera, lights, and surgical tools can be inserted through the tubes. Endoscopic mesothelioma biopsies are useful when the tumor has formed in a location that’s hard to reach directly through an incisional biopsy. The surgeon can take tissue samples during endoscopy.
What to Expect During an Endoscopic Mesothelioma Biopsy
Mesothelioma biopsies through endoscopy usually require a small incision. The tube is then inserted into your chest cavity or abdominal cavity. You will be under general anesthesia during the endoscopic procedure, but usually you will be able to go home the same day. Plan for several hours of recovery time and have someone drive you home after.
Endoscopic mesothelioma biopsies may require a smaller incision and therefore can have a faster healing time than incisional or excisional biopsies.
The Importance of Mesothelioma Biopsies
Close examination of the cells in your tumor is increasingly important with the advent of mesothelioma immunotherapy drugs. The tissue samples obtained in mesothelioma biopsies can provide information about cell mutations, DNA variations, and other cellular markers. This information helps doctors and researchers determine the best immunotherapy treatment for your tumor.
The science of immunotherapy and personalized cancer treatment is still evolving. It holds the promise of better outcomes and increased life expectancies for mesothelioma patients. As immunotherapy develops, mesothelioma biopsies could become an even more important element of mesothelioma diagnosis and treatment.