The diagnosis of malignant pleural Mesothelioma is made most firmly by the inspection of a biopsy of the pleura under the microscope. A diagnosis confirmed by biopsy helps when planning further treatment, for some treatments it is essential and it also verifies claims for compensation.
It may be possible to obtain a reliable biopsy either by the removal of fluid from the chest (pleural fluid cytology) or a needle biopsy whereby a biopsy is obtained under local anaesthetic sometimes guided by a CT or ultra sound scanner. However, particularly in the early stages, negative results by these tests do not rule out the possibility of Mesothelioma. It may be felt that a surgical biopsy is warranted.
There are two “keyhole” procedures that can be used. Under a local anaesthetic it is possible to have a medical thoracoscopy. This involves a small camera telescope being introduced through a single 1-2 cm cut from which a biopsy can be taken. If a general anaesthetic is performed, a thoracic surgeon may perform Video Assisted Thoracoscopic Surgery (VATS), through between 1 and 3 such cuts. This allows a larger biopsy to be performed and a full assessment of the pleura to be made.
Picture Source - www.thoracicgroup.com
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