What is a biopsy? How is it done? What kind of biopsy should I have done?
A biopsy is a sample of the tumor tissue to be analyzed by a doctor called a pathologist. There are many ways to obtain a biopsy sample. Which way is best for you depends on the location of your tumor.
Depending on where your tumor is located, there are many different ways to obtain a biopsy sample. Usually the easiest way is the best way. If you have fluid in the pleural space between your lung and chest wall, it will probably be drained to make you feel better. At the same time, a sample of the pleura can be taken with an instrument. This can be done by a surgeon, a pulmonologist (a doctor specializing in lung problems) or an interventional radiologist (a doctor trained to do procedures using x-ray images and other guidance). The fluid can also be sent for analysis, to see if there are any cancer cells in it.
If these tests to not get enough tissue for a good biopsy, the next step is usually a thoracoscopy.
For this procedure, a doctor inserts an instrument called a thorascope through an incision in the chest. He or she can directly visualize the tumor and take samples. The doctor can also get a good look inside the area to see how the lung appears to function, for example. He might also be able to take samples of lymph nodes in the area.
If this is not possible due to the location of the tumor, a direct biopsy might have to be done. In that case, a larger incision would be made and the tumor would be seen directly and a biopsy would be taken. This would be done under general anesthesia.
Biopsy specimens will be sent to a pathologist. The pathologist must use all the tools at his or her disposal to look at the cells and make a correct diagnosis. There are many different stains to color the cells. They can be evaluated under a regular microscope or electron microscope. There are now special stains that will help tell the pathologist if the tumor cells are mesothelioma cells and not from lung cancer.
If the pathologist is not 100% sure, it is common practice to then send the material to an expert pathologist to make sure of the diagnosis.