Introduction/Background*Histological diagnosis of female pelvic tumours is essential in their adequate and early clinical management. Ultrasound-guided biopsy is a routine diagnostic method to obtain tissue samples and used widely in different types of tumours. Pelvic solid masses can be biopsied via transabdominal, transvaginal, transrectal or transperineal routes. Generally, lesions located deep within the female pelvis are not easy to access transdabdominally due to various bowel loops, major vessels, uterus, urinary bladder and ureter being in the path of the needle.

Methodology We report our experience of transvaginal ultrasound (TVUS)-guided core biopsies involving 303 patients referred to the gynaecological ultrasound unit of our national comprehensive cancer centre. All patients who underwent a transvaginal, ultrasound-guided core needle biopsy sampling between March 2019 and December 2020 were included.

Result(s)*Adequate histologic specimens were obtained in 299 patients (98.7%). The most common sites of biopsy sampling were the adnexa (29.7%), the vaginal stump or wall (13.5%), the uterus (11.6%) and the peritoneum (10.2%). Malignancy was confirmed in two-thirds of patients (201/303) and a primary malignancy was diagnosed in 111 of the 201 histologically verified malignant cases (55.2%). Interestingly, 23.9% (48/201) of malignant tumours were proven to have a non-gynaecological origin. Among them, gastrointestinal tumours occurred the most frequently (31/48 patients). Three abscesses were discovered following the biopsy procedure, resulting in a complication rate of 1%. In 94 (31%) patients, subsequent surgery allowed the comparison of the ultrasound-guided and surgically obtained histologic results. We found inaccuracy in 12 cases (12.8%), which is discussed in this paper in detail. Sensitivity, specificity, PPV and NPV to diagnose malignancy was 94.8%, 94.1%, 98.7% and 80.0%, respectively.

Conclusion*According to our experience, TVUS-guided NCB is a safe and effective histological sampling procedure, providing adequate tissue for pathological evaluation in 99% of cases. It can reliably guide therapy as its performance is satisfactory compared to surgically obtained histology. As infectious complications might rarely occur, routine preoperative vaginal disinfection is suggested. In case of the suspicion of malignancy despite negative biopsy histology, further investigation is proposed due to the 80% NPV.