Jung Jae Park MD, Presenter: Nothing to Disclose

Chan Kyo Kim MD, PhD, Abstract Co-Author: Nothing to Disclose

Byung Kwan Park MD, Abstract Co-Author: Nothing to Disclose

Although several previous studies reported the utility of transvaginal approach for endometrial biopsy or fine needle aspiration of pelvic lesions, few studies have demonstrated the feasibility of transvaginal technique for biopsy of pelvic masses. The aim of our study was to evaluate the diagnostic accuracy and safety of ultrasound (US)-guided transvaginal core biopsy for pelvic masses.

Forty-nine pelvic masses (mean size, 4.2 ± 2.8 cm) in 49 women (median age, 59 ± 12.7 years) who received US-guided transvaginal core biopsy between 2009 and 2013 were enrolled in this retrospective study. On pre-biopsy CT or MR imaging, the lesions were identified in vaginal stump (n = 25), rectovaginal or vesicovaginal pouch (n = 11), adnexa (n = 8), or distal ureter (n = 5). The biopsy was performed using a probe equipped with a guide and an 18 gauge Tru-cut needle with an automatic biopsy gun (Ace-cut) after local anesthesia. We evaluated the diagnostic accuracy and complication rate of the procedure.

All acquired specimens were adequate and sufficient for pathologic analysis. Overall diagnostic accuracy of US-guided transvaginal core biopsy was 91.8% (45/49 patients). Of these, 39 lesions were diagnosed as malignancies and five lesions that revealed active or chronic inflammation without evidence of malignancy regressed spontaneously on follow-up imaging. The remaining one lesion was diagnosed as ovarian sex cord-stromal tumor. Of the four non-diagnostic lesions, two were identified as fibrothecoma and recurrent leiomyosarcoma after surgery, respectively and the remaining two were clinically regarded as recurrent ovarian and endometrial cancer due to increases in size on follow-up imaging, respectively. None of these biopsies resulted in major complications. As minor complications, vaginal bleeding immediately after the biopsy and gross hematuria were found in 10 patients (20.4%) and three patients (6.1%), respectively, but these complications were stopped spontaneously in all 13 patients without further treatment or transfusion.

US-guided transvaginal core biopsy appears to be reliable and safe procedure for the histologic diagnosis in patients with pelvic masses.

As a reliable and safe technique, US-guided transvaginal core biopsy can be used for clinical decision making and selecting optimal treatment strategies in patients with pelvic masses.

Park, J, Kim, C, Park, B, Ultrasound-guided Transvaginal Core Biopsy of Pelvic Masses: Feasibility, Safety and Short-term Follow-up.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14005918.html