Diagnosing malignant mesothelioma is difficult. The symptoms are often the same as other common diseases, such as pneumonia. In most cases, a biopsy is needed to confirm the diagnosis. According to www.radiologyinfo.org, “a biopsy is the removal of tissue from any part of the body to examine it for disease. Some may remove a small tissue sample with a needle while others may surgically remove a suspicious nodule or lump.”
In order to make a diagnosis using a needle biopsy, samples of tissues or cells are taken from the suspicious area. Depending on the location and the type of cancer suspected, doctors use two different types of needle biopsies, both performed with long thin needles. The two different types of needle biopsies are fine needle biopsy and core needle biopsies.
Fine needle biopsy, also known as fine needle aspiration, is a technique used to take a sample of a suspicious lump, lymph node, or growth. Some of these suspicious lumps may be close to the skin surface while others may be deeper. Sometimes, these types of biopsies are performed under ultrasound guidance or with the assistance of CT scans or MRIs. This is referred to as a cytopathology or cytology. Cytology tests, as opposed to tissue biopsy specimens, are easier to obtain, less painful, cause less complications and are less expensive. With a fine needle biopsy, the skin is not cut; instead, a simple puncture from the needle is made.
The first recorded fine needle aspiration took place at St. Bartholomew Hospital in the 1800’s in London, England, and there are reports dating back centuries of surgeons performing needle biopsies to look at suspicious tumors.
Fine Needle Aspiration Cytology is a method in which a fine needle is used to remove a sample of cells from a suspicious mass for diagnostic purposes. Fine Needle aspiration is recommended for cysts, nodules or masses. Most frequently, aspirations are done on breasts, thyroid glands, and lymph nodes in the neck, groin or other areas of the body. They are also performed on lung lesions, liver abnormalities, and certain pancreatic growths.
Core biopsies are another technique used to obtain a specimen. The needle used is slightly larger and it removes a small cylinder of tissue for testing. The needle is introduced and has a hollow inner cannula, allowing for multiple specimen samples from one needle stick. Core biopsies may sometimes take longer for the results to come back.
Depending on the clinical situation of the patient, these procedures can be done on an outpatient basis. The procedure is performed under local anesthesia or, depending on the situation, mild sedation. The puncture site is then covered with a band aid or a small dressing. Generally, Fine Needle Aspiration procedures are well tolerated, but there may be some slight discomfort at the site. Tylenol usually will take care of any discomfort. If intravenous sedation is used, patients will be advised to have someone to drive them home. Patients will also need to rest at home after the procedure.
Biopsy samples are immediately sent to a laboratory to be examined. Often, a Cytopathologist is on site to determine if enough cells have been obtained to make a diagnosis. This is done by staining the specimen and looking under the microscope.
Results can take up to a week or longer. Highly trained Interventional Radiologists perform the procedures. A doctor may elect to perform a diagnostic biopsy depending on the location, size, and consistency of the suspicious growth. The experience of the doctor performing the procedure is critical to an accurate diagnosis. The doctor will need to biopsy enough of the suspicious cells to make an accurate diagnosis.
There are three different possible results from a fine needle biopsy. A “benign” result tells us that the area cells are non-cancerous. A “malignant” result indicates that the specimen contains some cancerous cells. A “non-diagnostic” result means that the result is unclear and that further testing is required, either through a repeated procedure or an open biopsy.
Diagnosing malignant mesothelioma requires a tissue biopsy for the most accurate diagnosis. Overall, fine needle aspiration is thought to be diagnostically accurate in approximately 90-99% of cases. For malignant mesothelioma, needle biopsies are often used in conjunction with other tests to obtain a diagnosis.
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