Accuracy of Ttransvaginal Ultrasound- Guided Biopsy in Ovarian Cancer

Background: Cytoreductive surgery is the standard treatment of ovarian cancer in advanced stages, however sometimes, because the patient is inoperable, only a biopsy is carry out and the surgery will be terminated. Therefore, in such cases, trans-vaginal core needle biopsy of tumor is suggested to confirm the diagnoses of ovarian cancer; and then neo-adjuvant chemotherapy is performed based on pathology result and then the patient undergoes the main surgery. Trans-abdominal ultrasound-guided core needle biopsy from ascites or ovarian mass is also possible; nevertheless, the tumor might spread at the site of needle and cause abdominal wall metastasis. The aim of this study is to assess the accuracy of using trans-vaginal ultrasound-guided biopsy of ovarian cancers in stages 3 and 4, and to compare it with the pathology of abdominal biopsy and finally to follow-up the probable metastasis to vaginal cuff in a six- 12 month patient-related follow-up .Methods: This study was a diagnostic trial carried out from August 2016 to 2017 in the Department of Oncology of academic Hospital, Mashhad University of Medical Sciences. After initial assessment of clinical findings ( abdominal pain, abdominal enlargement, palpable mass in vaginal examination and lymph node evaluation , etc.) , radiological evidence (CT scan based on the probability of stages 3 and 4 ovarian cancer) and laboratory results (high level CA-125)we have chosen 12 patients suspected of having stage 3 or 4 ovarian cancer. Palpable mass was detected during vaginal examination in all the patients who were also laparotomy candidates. Results: The pathological results of vaginal biopsy in 8 patients (66.7%) was epithelial serous tumor and in 4 patients (33.4%) was epithelial mucinous tumor. The pathology of abdominal biopsy in final surgery also was in agreement in 100% of the cases. No evidence of metastasis to vaginal cuff was observed during vaginal examinations and Pap smear in 12 month follow-up period.Conclusion: Trans-vaginal ultrasound-guided biopsy is an accurate method in diagnosing the pathology of ovarian cancer in stage 3 or in patients with no possibility of optimal surgery