Ultrasound-guided core needle biopsy (CNB) of pelvic masses in gynecology

Introduction:

Due to advances in treatment options for advanced ovarian or peritoneal malignancies, there is a need for histologic sampling prior to neoadjuvant chemotherapy for cytoreduction. A biopsy may also be indicated in patients with a history of gynecologic malignancy and a suspected disease recurrence. The aim of our study was to retrospectively evaluate the indications, feasibility, diagnostic accuracy and safety of CNB performed in our gynecologic cancer center.

Material and Methods:

We reviewed the medical records of eight patients who underwent transvaginal or transabdominal US-guided core biopsy between May 2017 and April 2018. All biopsies were performed with an automatic biopsy gun (BARD®) after a detailed gynecologic ultrasound and informed consent. For the transvaginal approach, an attached needle guide and 18 Gauge/25 cm needles was used. Transabdominal biopsies were performed under local anesthesia with 14 – 16 Gauge/15 – 20 cm needles. We evaluated the indications, diagnostic accuracy and complication rate of the procedures.

Results:

Six transvaginal and two transabdominal CNBs were performed during the study period. Indications for CNB were patients with advanced ovarian, primary inoperable malignancies (n = 3), inoperable patients due to comorbidities (n = 2) and patients with suspicion of metastases or recurrence of gynecologic malignancies (n = 3). Representative samples were obtained in all cases. All procedures were tolerated with minimal discomfort on an outpatient basis. Of the 8 lesions, 7 were confirmed to be either benign (n = 2) or malignant (n = 5). One lesion was not histopathologically classified after biopsy. A CT scan guided biopsy showed adiponecrosis. No complications occurred during or after CNB procedures.

Conclusion:

Transvaginal and transabdominal ultrasound guided biopsy seems to be a feasible and safe procedure for histopathologic diagnosis of pelvic masses.