Ultrasound-guided tru-cut biopsy in the management of advanced abdomino-pelvic tumors

Objective: The goal of this study was to evaluate the accuracy and safety of ultrasound- guided tru-cut biopsy in patients with either primarily inoperable pelvic tumor, advanced tumor and compromised performance status, or recurrent pelvic tumor.

Methods: Consecutive patients referred in the Center for minimally invasive biopsy from Jan 2005 to Dec 2006 were included in the study. The tissue samples were obtained using an automatic bioptic gun (Fast Gun, Sterylab, Italy) in combination with a disposable tru-cut needle (Fast Cut Needle, Sterylab, Italy, 16G/250mm for transvaginal and 14–16 G/150–200mm for transabdominal biopsy) guided by ultrasound.

Results: Together 90 patients were enrolled and only 4 were not suitable for biopsy. The biopsy was taken either from pelvic tumor (54.6%), peritoneal metastases (31.4%), or omental cake (14%). Samples were obtained transvaginally (53.5%) or transabdominally (46.5%). A diagnosis consistent with primary ovarian malignancy was made in 62.8%, metastatic ovarian involvement was found in 10.5%, and extraovarian tumor in 26.7%. The diagnostic accuracy of ultrasound guided tru-cut biopsy reached 97.7%. There was only one complication, a bleeding from tumor in the patient with mild thrombocytopenia due to metastatic infiltration of bone marrow, requiring laparotomy.

Conclusion: Ultrasound-guided tru-cut biopsy is safe, reliable and cost-effective method. It can be performed in an outpatient setting without a need of general anesthesia and provides an adequate specimen for histological analysis including immunohistochemical methods. It should, therefore, be considered as a method of choice for histological verification of both advanced primary and recurrent pelvic tumors.