Image-guided biopsy of indeterminate ovarian masses appears safe and effective

1. Ultrasound- or computed tomography (CT)-guided ovarian mass biopsy yielded diagnostically sufficient samples with a sensitivity and specificity of 100% and 88%, respectively, for malignancy.

2. During the study period, ovarian biopsy procedures resulted in no complications, including no evidence of biopsy tract tumor seeding in patients with epithelial ovarian malignancies during an average follow-up period of 3.6 years.

Evidence Rating Level: 2 (Good)

Study Rundown: Ovarian malignancies commonly present with vague symptoms such as bloating or abdominal fullness and, once detected, are often found to be locally advanced or metastatic. Therefore, incidental detection of ovarian masses, particularly among postmenopausal women, requires a thorough diagnostic workup to exclude malignancy, often culminating in surgical removal. A frequently considered diagnostic alternative is image-guided biopsy, but few studies have examined the procedure’s diagnostic yield, and concern over tumor seeding of the biopsy tract has hindered widespread adoption.

The present study retrospectively examined a small cohort of postmenarchal women who underwent either CT- or ultrasound-guided core and fine needle aspiration biopsies of indeterminate ovarian masses. Diagnostic accuracy was assessed by comparing pathologic results from biopsy to those of surgical specimens or to subsequent imaging follow-up, as applicable. All biopsies provided adequate tissue samples for pathologic diagnosis, and sensitivity and specificity were both high. Additionally, no procedure-related complications occurred, including an absence of evidence of tumor seeding along the biopsy tract. Primary limitations of the study include the concern for selection bias inherent to all retrospective studies, variability in length of follow-up periods among subjects, and small sample size. Regardless, the study represents the largest trial to date to evaluate image-guided ovarian biopsy, and results strongly support the practice.

Click to the read the study in the Journal of Vascular Interventional Radiology

Relevant Reading: Image-guided biopsy in patients with suspected ovarian carcinoma: a safe and effective technique?

In-Depth [retrospective cohort]: A total of 27 postmenarchal patients aged 26-96 years (mean 61 years) with ovarian masses of indeterminate significance were retrospectively identified after having undergone image-guided biopsy using CT or ultrasound. All biopsies resulted in adequate tissue sampling for pathologic diagnosis regardless of imaging modality used for the procedure. Eighteen subjects (67%) had malignancies identified by biopsy, most commonly ovarian cancer (9 of 18) and metastases (6 of 18). Diagnostic accuracy was determined by pathologic comparison to surgical specimens or imaging follow-up over a mean period of 44.1 months. The resultant sensitivity and specificity of image-guided biopsy for malignancy was 100% and 88%, respectively. No procedural complications were identified, and among subjects with epithelial ovarian malignancies, no metastatic seeding of the biopsy tract was identified over an average follow-up period of 44.6 months.

Image: PD

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