Doctors will use more than one test to help accurately diagnose if the patient has mesothelioma. Biopsy is usually part of that testing regimen because it is a firsthand look at an actual piece of the tumor.
What is a Biopsy?
A biopsy is a procedure that removes a sample of tissue or cells from a living organism. There are a number of different types of procedures that can be used depending on from which area of the body the sample will be taken, the size of the sample needed, and for what type of disease it is being tested. The removed sample is sent to a lab to be evaluated by a pathologist that is a doctor who has training in the effects disease has on cells and tissue.
What are the Types of Lung Biopsies?
There are three types of lung biopsies:
- Percutaneous lung biopsy – The term “percutaneous” means through the skin. It is usually the biopsy method of choice when the abnormality is near the surface of the lung, or on the chest wall. This procedure is performed on an outpatient basis. The doctor will probably use a CT scanner or ultrasound to locate the exact site where the sample will be taken. The patient’s skin is cleaned and injected with a local antiseptic. An incision about 1/8 inches in length is made, and a biopsy needle/syringe is inserted into the tissue to be removed. If a tissue sample is needed, the needle will have a cutting tip. If a cell sample is needed, the needle will have a tip for aspirating cells. When cells are removed, it is referred to as a fine needle aspiration (FNA).
- Bronchoscopy – This is used when the abnormality is in the larger airways of the lung, or buried inside the chest in a location that would be too difficult to reach with a needle. It is also performed on an outpatient basis. The patient is given a mild sedative and the upper airways are injected with a local anesthetic. A bronchoscope is inserted through a natural opening, such as the mouth or the nose, and passed through the wind pipe into the bronchus. Tools that will be used to remove the sample are passed through the bronchoscope, and the procedure is performed while being monitored on the screen. In this type of procedure, collection will be for more than one sample. The entire time the procedure is being performed, the patient’s vitals, electrocardiogram tracings (which monitors heart rhythm), and blood oxygen are continually checked. Sometimes it is necessary to use an x-ray to help locate the tissue if it is not directly visible through the bronchoscope. An x-ray is also given to the patient after the procedure to check for pneumothorax, a condition in which air or gas can become trapped in the cavity between the lung and the chest wall and cause the lung to collapse. This is a common complication of bronchoscopy.
- Video-assisted open thoracic surgery – or VATS, is used when the malignancy will be removed during the procedure. That is why this procedure is performed in an operating room with the patient under general anesthesia. The chest cavity is opened using a small incision and a video camera is inserted into the chest through the incision. Two additional small incisions are made so that the instruments for sample collection/removal of the malignancy can be inserted. A tissue sample is removed and analyzed so that the determination can be made to continue with the rest of the removal. After the procedure, the incision is stitched. The surgeon may opt to leave one end of a chest tube inside the lung and the other end poking through the closed incision for a couple of days to allow trapped air/gas to escape and avoid the possibility of lung collapse.