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A tissue sample from the tumour (a biopsy) will usually be needed to confirm the diagnosis.
- Needle biopsy
You may be given a needle biopsy. First you will be given a local anaesthetic to numb the area, and a special type of needle is then passed through your skin into the tumour. A sample of tissue is then cut out. This is often done at the same time as fluid drainage. Your doctor or radiologist may do this using a CT scanner to guide the process (see CT scans, above).
These procedures are not associated with a high risk of complications. However your doctor will explain that there is a small risk of internal bleeding after the biopsy, and a small risk of air leaking from your lung (with a pleural biopsy). Even if they occur, these problems often settle without needing treatment. However it may be necessary to have a chest X-ray after the biopsy to check for these complications. If the results later confirm a mesothelioma tumour, there is a chance that tumour cells may have settled in the scar where your biopsy was taken. This might eventually cause a small swelling. It may be possible to prevent this by having a small dose of radiotherapy to the drain site once the mesothelioma diagnosis is confirmed.
Needle biopsy is sometimes called fine needle aspiration cytology (FNAC).
- Surgical biopsy
If the initial tests have not given a definite answer, but the doctor suspects there is still a chance that you may have a tumour, a surgical biopsy may be needed. You will be admitted into hospital. The operation is done while you are under a general anaesthetic. Keyhole surgery is usually used. Three small cuts are made between the ribs and into the pleura (the membrane lining the lungs). This lets the surgeon insert a camera, a light source and an operating instrument. The surgeon can then take biopsies and remove any fluid. Often, sterile talc is used as a glue to stick the layers of the pleura together and prevent fluid from coming back.
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