title: Image-guided ovarian mass biopsy: efficacy and safety.
abstract: OBJECTIVE
  Image-guided needle biopsy represents a minimally invasive method for pathologic diagnosis of a mass. This study evaluates the diagnostic yield, accuracy, and safety of ovarian mass biopsy with combined core and fine-needle technique.
  
  
  METHODS
  Medical records of all women at least 18 years of age, referred from gynecologic oncology, who underwent image-guided ovarian mass biopsy from 2001 through 2011 were reviewed. Among 27 patients, ultrasound guidance was used in 13 (48%), six transabdominal and seven transvaginal; computed tomography guidance was used in 14 (52%), nine transabdominal and five transgluteal. Biopsy indications were suspected metastasis (n = 15; 56%), suspected ovarian cancer to be treated with neoadjuvant chemotherapy (n = 10; 37%), and relative contraindication to surgery (n = 2; 7%). Mean maximum lesion dimension was 9.9 cm (range, 2-23 cm), with solid composition in nine (33%), cystic in six (22%), and mixed in 12 (44%). Biopsy pathologic findings were compared versus those of the surgical specimen or, for masses that were not resected, versus the stability of benign masses and response to chemotherapy of malignant masses on follow-up.
  
  
  RESULTS
  All biopsies yielded a diagnosis. No biopsy-related complications were noted. Eleven patients (41%) did not undergo lesion resection and were followed for an average of 28.8 months (range, 0.3-118.4 mo). In no patient did malignancy develop during clinical follow-up after a benign biopsy diagnosis. Sensitivity and specificity for diagnosis of malignancy were 100% ± 0 (19 of 19) and 88% ± 26 (seven of eight), respectively, for cancer detection. In nine patients (33%) with final pathologic diagnosis of epithelial ovarian cancer, tumor seeding was not observed during a mean follow-up of 44.6 months (range, 1.3-110.2 mo).
  
  
  CONCLUSIONS
  Image-guided ovarian mass core needle biopsy results in a pathologic diagnosis of benign and malignant masses with high yield, accuracy, and safety.
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 25 New Chardon St., Suite 501, Boston, MA 02114.
authors.forename: Ashraf
authors.initials: A
authors.lastname: Thabet
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 25 New Chardon St., Suite 501, Boston, MA 02114. Electronic address: bsomarouthu@mgh.harvard.edu.
authors.forename: Bhanusupriya
authors.initials: B
authors.lastname: Somarouthu
authors.affiliation: Department of Pathology, Massachusetts General Hospital, Harvard Medical School, 25 New Chardon St., Suite 501, Boston, MA 02114.
authors.forename: Esther
authors.initials: E
authors.lastname: Oliva
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 25 New Chardon St., Suite 501, Boston, MA 02114.
authors.forename: Debra A
authors.initials: DA
authors.lastname: Gervais
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 25 New Chardon St., Suite 501, Boston, MA 02114.
authors.forename: Peter F
authors.initials: PF
authors.lastname: Hahn
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 25 New Chardon St., Suite 501, Boston, MA 02114.
authors.forename: Susanna I
authors.initials: SI
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D062005:Biopsy, Large-Core Needle / Q000379:methods; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D010053:Ovary / Q000000981:diagnostic imaging / Q000473:pathology; D015641:Radiography, Interventional / Q000009:adverse effects / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000009:adverse effects / Q000379:methods; D018084:Ultrasonography, Interventional / Q000009:adverse effects / Q000379:methods*