Introduction/Background Ultrasound-guided biopsy is a reliable and effective technique for obtaining tissue samples. It is commonly used for different types of tumors, such as breast and prostate cancers to accelerate the treatment process. Our aim is to evaluate the indications, adequacy, and safety of transvaginal ultrasound-guided biopsy in women with pelvic lesions suspected of gynecologic malignancy.

Methodology We reviewed the medical records of 90 patients who had undergone transvaginal or transabdominal ultrasound-guided biopsy at the division of gynecologic oncology between 2012–2022. Patients who have suspected ovarian malignancy but are not suitable for optimal debulking surgery, or the origin and/or nature of the tumor was unclear and further management required histological verification.

Results Two patients gave up the treatment process and 88 women were analyzed. Of the patients, 55 and 33 underwent transabdominal and transvaginal biopsy respectively. Biopsy material was found to be sufficient in 85 of 88 cases. Histopathological examinations revealed primary ovarian tumor in 58 (68%) cases. Tuberculosis was found to be the second most common disease (n=12, 14%). Metastatic tumors and tuba ovarian abscess was found to be in 10 (12%) and 5 (6%) patients respectively. No major complications occurred.

Conclusion Ultrasound-guided biopsy via abdomen and/or vagina is a minimally invasive method to obtain adequate material for histological diagnosis and management of adnexal mass and could avoid unnecessary surgical procedures in selected patients.