Article Text

Download PDFPDF
Transvaginal ultrasound-guided biopsy in patients with suspicious primary advanced tubo-ovarian carcinoma
  1. Floriana Mascilini1,
  2. Lorena Quagliozzi1,
  3. Mariateresa Mirandola1,
  4. Francesca Moro1,
  5. Nicoletta D’Alessandris1,
  6. Francesca De Felice2,
  7. Antonia Carla Testa1,3,
  8. Giovanni Scambia1,3 and
  9. Anna Fagotti1,3
  1. 1 Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
  2. 2 University of Rome La Sapienza, Rome, Italy
  3. 3 Università Cattolica del Sacro Cuore, Istituto di Clinica Ostetrica e Ginecologica, Roma, Italy
  1. Correspondence to Dr Anna Fagotti, Policlinico Universitario Agostino Gemelli Dipartimento Scienze della Salute della Donna e del Bambino, Roma 00168, Italy; anna.fagotti{at}


Objective To assess the accuracy of pathological diagnosis by transvaginal ultrasound-guided biopsy versus surgery in patients with suspicious primary advanced tubo-ovarian carcinoma. The Feasibility, adequacy, and safety of the procedure were also evaluated.

Methods Consecutive women with pre-operative suspicious primary advanced tubo-ovarian carcinoma presenting between July 2019 and September 2021 were enrolled. Accuracy was calculated including only cases who underwent surgery. Feasibility was defined as the number of cases in which ultrasound-guided biopsy was possible according to tumor characteristics (morphology and site). Adequacy was defined as the number of conclusive diagnoses out of the samples collected. Safety was defined by the number of major complications which were defined as hospitalization, surgery, and/or blood transfusion.

Results A total of 278 patients were eligible for the study; 158 were enrolled, while 120 were excluded for logistic reasons or patient refusal. Ultrasound-guided biopsy was not feasible in 30 (19%) patients. The samples obtained in the remaining 128 patients were all adequate (100%), and no major complications were noted. A total of 26 (20%) patients started neoadjuvant chemotherapy on the basis of the diagnosis obtained by ultrasound, whereas 102 (80%) patients underwent surgery. Accuracy of ultrasound-guided biopsy versus surgery was 94% (96/102), with six false negative cases at ultrasound (6%). Site (prevesical peritoneum) and size (<8 mm) of the nodules resulted as major predictive factors for ultrasound-guided biopsy failure (false negative). Ultrasound-guided biopsy correctly identified 86 primary invasive tubo-ovarian carcinomas and 10 metastatic tumors.

Conclusion Ultrasound-guided biopsy is a feasible, safe, and accurate method to provide histological diagnosis in suspicious advanced tubo-ovarian cancer patients.

  • Ovarian Cancer
  • Gynecologic Surgical Procedures
  • Laparoscopes

Data availability statement

Data are available in a public, open access repository.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

Data are available in a public, open access repository.

View Full Text


  • Twitter @annafagottimd

  • Contributors FMa and LQ performed the study design, patient recruitment, data analysis and interpretation, statistical analysis, and wrote the report. AF, ACT, and GS supervised the whole process. FMo, ACT, AF, and GS participated in patient recruitment. LQ, FMa, ADN, and MM contributed to data collection and curation. FDF contributed statistical analysis. AF was the guarantor. All authors approved the final report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.