In the book 100 Questions and Answers About Mesothelioma the authors ask the following: “How are biopsies performed and which one is right for me?” In my years of working with people that have been diagnosed with mesothelioma, when reviewing their medical records I find that often the majority of the time fluid obtained from a thoracentesis or paracentesis is inconclusive for a mesothelioma diagnosis.

While the removal of the fluid provides relief, it is very difficult to secure a firm diagnosis of mesothelioma. Why? Because sometimes the abnormal cells are so slight that they are impossible to tell apart from benign, reactive mesothelial cells or other large cells that contain waste or foreign bodies. And, if no abnormal or malignant cells are found in the fluid the patient is often misdiagnosed.

Problems arise when the procedure does not yield sufficient cells to perform the special staining required to diagnose mesothelioma. Extracted fluid that is very thick tends to contain more cells, making evaluation by way of immunohistochemical (IHC) or special staining easier to secure a diagnosis of mesothelioma.

The procedure to obtain fluid for cytological analysis requires a local anesthesia and a special needle to drain the fluid. This procedure can normally be performed in the doctor’s office.

A pleural biopsy consists of fluid and a small amount of tissue from the pleura. If the immunohistochemical staining (sometimes referred to as immunos) comes back as inconclusive, then more evasive procedures may be required to confirm a diagnosis. Your doctor may perform a thoracoscopy (a lighted scope with or without a camera). This involves making a small incision in your chest wall and placing a thin tube, called a thoracoscope, into your chest. This enables your physician to look inside your chest and obtain tissue samples. Not only can this procedure obtain tissue samples necessary to confirm a mesothelioma diagnosis, it can also help your doctor determine the amount and whereabouts of the disease, which helps to formulate a treatment plan.

If, through radiological observation, there appears to be more solid tumor than fluid, then your doctor will recommend an open biopsy. The incision is determined by the size of the thickened pleura and should be done by a thoracic surgeon with knowledge of mesothelioma. Normally a tissue sample measuring from 1 to 1½ inches in diameter is harvested to provide the pathologist adequate tissue to make a diagnosis.

You should follow your doctor’s advice on which procedure should be used for your diagnosis, as your doctor is the best one to determine your physical ability to undergo these diagnostic procedures.

Every day – even this very minute – dedicated researchers are diligently working to advance our ability to diagnose mesothelioma through immunohistochemical staining and other special procedures less evasive in hopes that early detection may aide in the treatment of mesothelioma patients.