A biopsy is defined as “an examination of tissue removed from a living body to discover the presence, cause, or extent of a disease.” In diagnosing mesothelioma, a biopsy is considered the “gold standard” meaning it is the single most important procedure when arriving at an accurate diagnosis. Although mesothelioma can, in some cases, be diagnosed from testing fluids (pleural effusion or ascites), the biopsy is considered the most reliable diagnostic tool.
Needle biopsy
A tissue biopsy simply means that the clinician removes a part of the suspected tissue (suspected mesothelioma) for closer examination. Most biopsies are needle biopsies, meaning a needle is used to access the suspicious tissue. Sometimes a CT-guided biopsy will be used. In this case, the patient rests in a CT-scanner and the scanner’s images help doctors determine the exact position of the needle.
Pneumothorax
In some cases where possible pleural mesothelioma is being investigated, the needle can create a small hole in the lung which can cause air to fill the space between the lung and chest wall. This is called a pneumothorax and, depending on the size, could require treatment such as using a catheter to vacuum out the trapped air.
Endoscopic biopsies
Endoscopic biopsy is commonly used in mesothelioma diagnosis. An endoscope is a thin instrument that has a light and a lens (or video camera) and usually has a tool to remove tissue samples. Endoscopes have different names depending on the part of the body where they’re used.
Suspected Pleural Mesothelioma
Thoracoscope for thoracoscopy:
An endoscope called a thoracoscope is used to look at areas inside the chest and at the pleura and take tissue samples for biopsies. Thoracoscopy is generally performed in the operating room under general anesthesia. The doctor inserts the thoracoscope through one or more small incisions made in the chest. Thoracoscopy can also be used as part of a procedure to remove fluid from the chest. This is called pleurodesis.
Suspected Peritoneal Mesothelioma
Laparoscope for laparoscopy:
An endoscope called a laparoscope is used to look inside the abdomen and take a sample (biopsy) of any peritoneal tumors. This is usually done in the operating room while the patient is under general anesthesia. The laparoscope is inserted into the abdomen through small abdominal incisions.
Surgical biopsy
If a needle or endoscopic biopsy is not sufficient, doctors may recommend a more invasive surgical biopsy. Here, either open or laparoscopic surgery may be necessary to obtain hard-to-reach tissue.
Once biopsy material is obtained, it is given to a pathologist so that this doctor can use various tools and tests to identify precisely what tissue or cancer has been removed from the patient.
Mesothelioma Mimics Ovarian Cancer: Lessons from a Case Report-Mesothelioma mimics ovarian cancer in a new report by Radiology Case Reports. Mesothelioma is a rare and very aggressive tumor of the peritoneum. Similar clinical and imaging presentations mean mesothelioma mimics ovarian cancer at times. Yet, a history of asbestosis exposure is key as the main risk factor for mesothelioma. Imaging plays a key role in getting the diagnosis correct. It narrows down the diagnosis possibilities. Ultrasound-guided biopsy with histological study can confirm a mesothelioma diagnosis. Case Report Misdiagnosis The Bangladesh National Institute of Oncology recently published a case report. A 42-year-old woman reported pelvic pain and progressive abdominal distension. An abdominal ultrasound revealed a high volume anechoic peritoneal effusion. Further investigation showed extensive peritoneal disease and bilateral ovarian tissue … Continue reading Mesothelioma Mimics Ovarian Cancer: Lessons from a Case Report»
Diagnostic Accuracy of Lung Fluid Tests for Mesothelioma-Researchers in Germany say the diagnostic accuracy of lung fluid tests for mesothelioma is high enough that they can be routinely used for diagnosis. Right now, if mesothelioma is suspected, doctors may order a fluid test first. If the fluid test (cytology) is positive, the doctor usually orders a tissue biopsy (histology) to confirm. But the German team says their study shows that the diagnostic accuracy of cytology is almost as good as histology for mesothelioma – especially when doctors consider the patient’s hyaluronic acid level, too. Scientists from several German institutions analyzed cytology tests from more than 4,500 suspected cases of pleural mesothelioma. They conclude that cytology is accurate enough to be used routinely for diagnosis. The Importance of … Continue reading Diagnostic Accuracy of Lung Fluid Tests for Mesothelioma»
Misdiagnosis of Mesothelioma More Common with Cytology Alone-A new set of case reports illustrates how easily misdiagnosis of mesothelioma can happen when the diagnosis is based on cytology alone. Cytology tests look at the cells in body fluids. For peritoneal mesothelioma patients, this is often the fluid that collects in their abdomen called ascites. But doctors from India’s Dayanand Medical College and Hospital say using ascites samples alone to diagnose mesothelioma is a risky practice. Misdiagnosis of mesothelioma may delay proper treatment and negatively impact survival. The Difficulty of Diagnosing Peritoneal Mesothelioma Malignant mesothelioma only impacts about 2,500 people in the US every year. It is most common among people who have lived or worked around asbestos. Peritoneal mesothelioma is even rarer. About a fifth of patients … Continue reading Misdiagnosis of Mesothelioma More Common with Cytology Alone»
Immunohistochemical Staining and Sarcomatoid Mesothelioma: Beyond the Lab-When it comes to understanding individual cases of sarcomatoid mesothelioma, doctors should not rely too heavily on immunohistochemical staining. That conclusion comes from mesothelioma researchers at MD Anderson Cancer Center in Texas. The researchers just released a new study focused on this rare mesothelioma subtype. A patient’s subtype has an impact on what kind of treatment could work best for them. Sarcomatoid mesothelioma is usually less responsive to chemotherapy. Immunohistochemical staining is a pathology technique. It is the main way that doctors tell the difference between mesothelioma subtypes. But the MD Anderson report suggests that not all cases of sarcomatoid mesothelioma are created equal. The researchers say it is important to look beyond the lab findings to understand individual cases. … Continue reading Immunohistochemical Staining and Sarcomatoid Mesothelioma: Beyond the Lab»
Mesothelioma Subtypes Often Misclassified by Biopsy-Pleural biopsy is not perfect when it comes to telling the difference between the three mesothelioma subtypes. But misclassification could lead to shorter survival. That is the conclusion reached by top mesothelioma researchers in Brescia, Italy. They compared autopsy records from 134 Italian mesothelioma patients. The patients were either shipyard workers or their spouses. The researchers found that the mesothelioma subtypes identified from biopsy tissue were incorrect a large percent of the time. Misclassification matters because it impacts which mesothelioma treatments doctors choose. The Three Mesothelioma Subtypes Pleural mesothelioma is an aggressive malignancy on the lung lining. It is caused by exposure to asbestos. Mesothelioma cells fall into three mesothelioma subtypes based on certain cellular characteristics. Pleural mesothelioma is notoriously … Continue reading Mesothelioma Subtypes Often Misclassified by Biopsy»
Irradiating Procedure Tracts Reduces Metastatic Mesothelioma in New Study-Irradiating the tracts through which certain interventions are performed can reduce the risk of metastatic pleural mesothelioma. That word comes from a new study in Singapore. The pleural form of malignant mesothelioma occurs on the lining around the lungs. Doctors often have to insert tools through the chest wall for diagnosis or treatment. The paths or tracts along which they insert those tools can be the site of new mesothelioma tumors. But the study shows that timely radiation treatment of those paths may prevent metastatic pleural mesothelioma. Metastatic Pleural Mesothelioma Metastasis is when cancer cells move from their original site to another place in the body. A tumor that is contained in one spot is easier to treat or remove. … Continue reading Irradiating Procedure Tracts Reduces Metastatic Mesothelioma in New Study»
Visualizing the Immune Profile of Mesothelioma Patients-Researchers at MD Anderson Cancer Center in Houston have come up with a better way to analyze the immune profile of people with malignant mesothelioma. A person’s immune profile is the unique set of immune system cells and how they are working at any given time. The functionality of immune system cells in the area right around the tumor – the tumor microenvironment or TME – is especially telling. The system developed at MD Anderson assigns different colors to key immune system markers. They applied the color system to a sample from the microenvironment of mesothelioma tumors. The result was an image of each tmor’s immune profile. These images could help doctors determine new targets for mesothelioma treatment. What is … Continue reading Visualizing the Immune Profile of Mesothelioma Patients»
Medical Thoracoscopy Safe and Effective for Mesothelioma Diagnosis-UK researchers say a minimally invasive procedure called medical thoracoscopy is safe and effective for diagnosing mesothelioma and treating its symptoms. The word comes from a large medical center in Northumberland. The UK has one of the highest rates of pleural mesothelioma in the world. Rates of pleural mesothelioma in Northumberland are especially high. Mesothelioma diagnosis usually requires a biopsy. The new study finds that medical thoracoscopy enabled “high diagnostic sensitivity” with few serious complications. Understanding Medical Thoracoscopy Medical thoracoscopy is a minimally invasive procedure for diagnosing and treating diseases affecting the pleura. The pleura is a membrane that surrounds the lung. People with mesothelioma and some other diseases can develop fluid between the pleura and the lungs. The fluid is … Continue reading Medical Thoracoscopy Safe and Effective for Mesothelioma Diagnosis»
WHO to Recognize Fourth Mesothelioma Subtype-The World Health Organization will soon recognize mesothelioma in situ as a fourth mesothelioma subtype. The 2015 WHO classification of pleural mesothelioma includes three histological subtypes. Pathologists can tell the difference between the subtypes by looking at the cells under a microscope. Each subtype has a slightly different cell shape, growth pattern, and nuclear characteristics. The proposed fourth mesothelioma subtype is a very early form of mesothelioma. Previous studies suggest that it may be a precursor to invasive mesothelioma. If patients know they have it, they may have years to try to keep mesothelioma from developing. Differences Between the Subtypes Pleural mesothelioma is a very rare type of cancer. Only about 2,500 people in the US receive a mesothelioma diagnosis … Continue reading WHO to Recognize Fourth Mesothelioma Subtype»
Mesothelioma Biopsies: Ultrasound Guidance Beats CT-A new study concludes that ultrasound guided mesothelioma biopsies are safer and just as effective as CT guided biopsies. Italian researchers analyzed both types of guidance systems for collecting tissue samples from mesothelioma patients. They compared the diagnostic yield and safety of each method. It turns out that ionizing radiation is not necessary for successful mesothelioma biopsies. As long as the technician is experienced, ultrasound guidance may be the better choice. The Importance of Mesothelioma Biopsies Pleural mesothelioma is a rare but highly aggressive kind of cancer. It grows on the membrane that surrounds the lungs. By the time patients experience symptoms of mesothelioma, the disease is often very advanced. Malignant mesothelioma can be tricky to diagnose. Mesothelioma biopsies are … Continue reading Mesothelioma Biopsies: Ultrasound Guidance Beats CT»
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