Ultrasound-guided core needle biopsy: evaluating adequacy, accuracy, and safety in gynecologic oncology

Tissue biopsy is an important component of pre-surgical pathologic diagnosis of cancer for treatment planning and clinical research. Core needle biopsy, or Tru-Cut biopsy, was introduced in the 1960s and 1970s but has not yet become routine in gynecologic oncology, and few studies have examined its adequacy or accuracy in this setting. We report our experience of ultrasound-guided core needle biopsy in patients with gynecologic malignancies.

We conducted a retrospective study of ultrasound-guided core needle biopsy at a single tertiary hospital in Prague, Czech Republic, using electronic medical records of cases between 2010 and 2022. We examined the adequacy of biopsy samples, accuracy relative to surgical pathology specimens, and safety. Ultrasound-guided core needle biopsy was performed using standardized procedures.

A total of 690 core needle biopsy procedures were evaluated (456 in newly diagnosed cases and 234 in recurrent cases), including 16 repeat procedures, in 674 patients. The 3 most common biopsy sites were ovary (29.3%), carcinomatosis (17.4%), and indeterminate pelvic mass (10.2%). Most (85.9%) biopsies retrieved 3 tissue samples. Core needle biopsy was adequate to establish a diagnosis in 622 of 690 cases (90.1%), and repeat core needle biopsy yielded an additional 16 adequate samples (2.3%). The adequacy rate was highest for ovarian biopsies (96.6%) and lowest for uterine body biopsies (83.3%). Pathologic assessment of core needle biopsy agreed with surgical specimens in 263 of 273 patients who underwent surgery, with an accuracy rate of 96.3%. There was no clear correlation between inaccurate biopsy results and final histotypes. Complications occurred in 9 of 690 core needle biopsy procedures (1.3%), including 6 cases of intra-procedural bleeding (3 required hospitalization), 2 cases of infection, and 1 case of a psychogenic reaction (non-epileptic seizure).

Ultrasound-guided core needle biopsy is an accurate, well-tolerated technique that provides reliable diagnostic tissue in gynecologic oncology and may be considered a preferred approach for initial evaluation and confirmation of disease.