[Ultrasound-guided intervention in the treatment of abdomino-pelvic advanced tumors].

Objective: The goal of this study was to evaluate the accuracy and safety of ultrasound-guided tru-cut biopsy in advanced abdomino-pelvic tumors in a sufficiently large cohort.

Design: Prospective study.

Setting: Oncogynecological Center, Department of Obstetrics and Gynecology, General Faculty Hospital of Charles University, Prague.

Methods: Patients indicated for tru-cut biopsy were those with primarily inoperable tumors, with advanced tumors and compromised performance status preventing a primary surgical procedure, and with recurrent pelvic tumors requiring histological verification. All were referred to the Oncogynecological Center between January 2005 and June 2007. Tru-cut biopsy was taken either from pelvic tumor or from its metastatic sites transvaginally or transabdominally under ultrasound guidance. Sample adequacy was evaluated.

Results: Altogether, 119 patients were referred for tru-cut biopsy during a study period. Only 4 cases were found unsuitable for tru-cut biopsy and the patients were referred for laparoscopy instead. Samples were obtained transvaginally in 67 patients (58.3%) and transabdominally in 48 patients (41.7%). The biopsy was taken from pelvic tumor in 59 patients (51.3%), omental cake in 14 patients (12.2%), from peritoneal visceral or parietal carcinomatosis in 37 patients (32.2%) and from other localities in 5 patients (4.3 %). The diagnostic adequacy of ultrasound-guided tru-cut biopsy reached 94.8% (95% CI, 94.17-99.40%). There were only two tru-cut biopsy-related complications: The first case involved bleeding from tumor in a patient with mild thrombocytopenia that required laparotomy; in the second case, diagnostic laparoscopy was indicated after a minor bleeding occurred in the biopsy site on ultrasound, however, no significant pelvic bleeding was confirmed by the procedure.

Conclusion: Ultrasound-guided tru-cut biopsy is a safe, reliable, fast, and cost-effective diagnostic method for histological verification of both advanced primary and recurrent abdomino-pelvic tumors. It can be performed in an outpatient setting without the need for general anesthesia, causing a minimal discomfort to the patient in comparison with laparoscopy or laparotomy. The risk of complications is low and the main advantage is the acquirement of a sample adequate for further immunohistochemical examination, which is a necessary requirement for the choice of optimal oncological treatment.