Contribution of Outpatient Ultrasound Transvaginal Biopsy and Puncture in the Diagnosis and Treatment of Pelvic Lesions: A Bicenter Study

Abstract

Background: The use of transvaginal ultrasound guided biopsy and puncture of pelvic lesions is a minimally invasive technique that allows for accurate diagnosis. It has many advantages compared to other more invasive (lower complication rate) or non-invasive techniques (accurate diagnosis). Furthermore, it offers greater availability, it does not radiate, enables the study of pelvic masses accessible vaginally with ultrasound control in real time, and it is possible to use the colour Doppler avoiding puncturing large vessels among others. The main aim of the work is to describe a standardized ambulatory technique and to determine its usefulness. Methods: This is a retrospective study of ultrasound transvaginal punctures (core needle biopsies and cytologies) and drainages of pelvic lesions performed on an outpatient basis during the last two years. The punctures were made with local anesthesia, under transvaginal ultrasound guidance with an automatic or semi-automatic 18G biopsy needle with a length of 20–25 cm and a penetration depth of 12 or 22 mm. The material obtained was sent for anatomopathological, cytological and/or microbiological study if necessary. Results: A total of 42 women were recruited in two centers. Fifty procedures (nine punctures, seven drains, and 34 biopsies) were performed. In five cases the punction and drain provided clinical relief in benign pelvic masses. Regarding material of the biopsies performed, 15 were vaginal in women previously histerectomized, finding 10 carcinomas, eight were ovarian tumours in advanced stages or peritoneal carcinomatosis obtaining the appropriate histology in each case, seven were suspicious cervical biopsies finding carcinomas in five of them, three were myometrial biopsies including one breast carcinoma metastasis in the miometrium and a benign placental nodule, and a periurethral biopsy was performed on a woman with a history of endometrial cancer confirming recurrence. The pathological diagnosis was satisfactory in all cases, confirming the nature of the lesion (25 malignant—ten vaginal recurrences of previous gynaecological cancers, eight cases of primary ovarian/peritoneal carcinoma, four new diagnosis of cervical malignant masses, one cervical metastasis of lymphoma, one periurethral recurrence of endometrial carcinoma and one recurrence of breast cancer in the myometrium—and 23 benign). The tolerance was excellent and no complications were detected. Conclusion: The ambulatory ultrasound transvaginal puncture and drainage technique is useful for obtaining a sample for pathological and microbiological diagnosis with excellent tolerance that can be used to rule out the recurrence of malignant lesions or progression of the disease, diagnose masses not accessible to gynecological exploration (vaginal vault, myometrium or cervix) and for early histologic diagnosis in cases of advanced peritoneal carcinomatosis or ovarian carcinoma as well as drainage and cytological study of cystic pelvic masses.

Ultrasound Features and Ultrasound Scores in the Differentiation between Benign and Malignant Adnexal Masses

“…Moderate-severe ascites was found in seven cases (5.2%) with benign adnexal masses, all of them corresponding to ovarian fibromas as in Meigs´ syndrome [ 39 ] ( Figure 2 ) and in eight malignant ones (15.1%), showing significant difference between both groups. However, our series could be biased since some of the adnexal tumors in advanced stages (for example, peritoneal carcinomatosis) benefited from a transvaginal US-guided biopsy [ 11 ] instead of surgical biopsy and were treated initially with neoadjuvant chemotherapy prior to surgery. Two cases of free liquid in the pelvis corresponded to blood in relation to a ruptured endometrioma.…”

“…The women included had a US study performed 180 days or less before surgery, whose images/US medical report were saved in the hospital’s PACS (Picture Archiving and Communication System) or in the ultrasound equipment. Adnexal masses studied histologically by ambulatory transvaginal ecoguided biopsy were published elsewhere [ 11 ]. US medical report included US features described below.…”

Application of Ultrasound Scores (Subjective Assessment, Simple Rules Risk Assessment, ADNEX Model, O-RADS) to Adnexal Masses of Difficult Classification

“…This is a retrospective study of consecutive women who underwent surgery for adnexal masses from January 2021 to December 2022 in the Department of Gynecology of a tertiary-care university hospital in Madrid (Spain). Other adnexal masses with ambulatory ecoguided biopsy have been analysed elsewhere [10] and were not included in this sample.…”