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Ultrasound-guided transvaginal biopsies of pelvic lesions: diagnostic yield, safety profile, and technical considerations over a 20-year experience

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Abstract

Purpose

To evaluate diagnostic yield, safety profile, and specific technical considerations of transvaginal ultrasound (TVUS) guided biopsy/aspiration.

Materials/methods

TVUS guided biopsy (core, FNA) procedures with pre-procedure CT/MRI imaging at a single institution between 2001 and 2021 were reviewed. Relevant patient demographic data was extracted via the Electronic Health Record (EMR), technical details of the biopsy procedure were collected, and distance to target via transvaginal and transabdominal biopsy approach was measured on pre-procedure imaging. Surgical pathology was reviewed and assessed for concordance. Complications were assessed. Statistical analysis was performed using SPSS.

Results

96 TVUS procedures (mean age, 58.7 ± 15.2 years; mean BMI, 27.4) were reviewed. TVUS guided approach decreased the distance to target (mean, 1.1 cm vs 8.6 cm transabdominal; p < 0.0001) and created a safe path not otherwise available in two patients. Average lesion size was 4.0 ± 2.1 cm (IQR 2.5, 5.2 cm) and targets at or above the vaginal cuff (0.9 ± 1.5 cm) and up to 0.5 ± 1.0 cm above the acetabular roof were accessible. 75 (78%) cases were core biopsies (18G; median, 2 passes) and 21 were FNA. Conscious sedation was used in 84.4% (n = 81) of cases and local anesthetic was also used in 84.4% (n = 81) of cases. Overall diagnostic yield was 98.9% (n = 94) with 94.7% (n = 89) cases confirmed as concordant diagnoses, including 57.4% (n = 54) malignant. Complications occurred in eight patients (8.3%), all minor. No post-biopsy infections were encountered regardless of administration of pre-procedure antibiotics (n = 14, 14.6%,), documentation of sterile prep (n = 92, 95.8%), or speculum use (n = 19, 19.8%). 50% (n = 48) had a prior hysterectomy, with no association with adequacy or complications (p = 0.9).

Conclusion

Transvaginal biopsy of pelvic lesions offers excellent diagnostic yield and favorable safety profile, and can dramatically decrease distance to target.

Clinical relevance

Ultrasound-guided transvaginal approach offers a safe and effective way to biopsy pelvic lesions in women.

Graphical abstract

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Authors and Affiliations

  1. University of Wisconsin School of Medicine and Public Health, 750 Highland Ave, Madison, WI, 53726, USA

    Erika J. Wood

  2. Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Perry J. Pickhardt, Matthew Elissa, Lori Mankowski Gettle & Meghan G. Lubner

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  1. Erika J. Wood
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  2. Perry J. Pickhardt
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Correspondence to Erika J. Wood.

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Conflict of interest

PJP: Advisor to Bracco, shareholder in Elucent, SHINE and Cellectar Biosciences. MGL: Prior grant funding, Ethicon, Philips; EW, ME, LMG: No relevant disclosures.

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Wood, E.J., Pickhardt, P.J., Elissa, M. et al. Ultrasound-guided transvaginal biopsies of pelvic lesions: diagnostic yield, safety profile, and technical considerations over a 20-year experience. Abdom Radiol 48, 1154–1163 (2023). https://doi.org/10.1007/s00261-022-03792-y

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