1329. Transvaginal Ultrasound-Guided Biopsy: Diagnostic Yield and Safety Profile Over a 20-Year Single Institution Experience
Authors* Denotes Presenting Author
Erika Wood;
University of Wisconsin School of Medicine and Public Health
Perry Pickhardt;
University of Wisconsin School of Medicine and Public Health
Matthew Elissa;
University of Wisconsin School of Medicine and Public Health
Lori Mankowski Gettle;
University of Wisconsin School of Medicine and Public Health
Meghan Lubner *;
University of Wisconsin School of Medicine and Public Health
Objective:
To evaluate diagnostic yield and safety profile of transvaginal ultrasound (TVUS) guided biopsy/aspiration.
Materials and Methods:
TVUS guided biopsy (core, FNA) procedures with preprocedure CT/MRI imaging at a single institution between 2000 and 2021 were reviewed. Relevant patient demographic data was extracted via EMR, technical details of the biopsy procedure collected and distance to target via transvaginal and transabdominal biopsy approach was measured on preprocedure imaging. Surgical pathology was reviewed and assessed for concordance. Complications were assessed. Statistical analysis was performed using SPSS.
Results:
A total of 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 10.7 mm vs 86.0 mm transabdominal, p < 0.0001) and created a safe path not otherwise available in 2 patients. Average lesion size was 40 ± 21 mm (35, 90 mm) and targets at or above the vaginal cuff (9.1 ± 15.0 mm) and up to (5.1 ± 10.4 mm) above the acetabular roof were accessible. 75 (78%) cases were core biopsies (18G; median, 2 passes) and 21 cases 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 and 57.4% (n = 54) malignant. Complications occurred in 8 patients (8.3%), all minor. No post-biopsy infections were encountered regardless of administration of preprocedure antibiotics (n = 14, 14.6%,), documentation of sterile prep (n = 92, 95.8%), or speculum use (n = 19, 19.8%). A total of 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. Ultrasound guided transvaginal approach offers a safe and effective way to biopsy pelvic lesions in women.
