ISUOG/ESGO Consensus Statement on ultrasound-guided biopsy in gynecological oncology

Abstract

The International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) with the European Society of Gynaecological Oncology (ESGO) jointly developed clinically relevant and evidence-based statements on performing ultrasound-guided biopsies in gynecological oncology. The objective of this Consensus Statement is to assist clinicians, including gynecological sonographers, gynecological oncologists and radiologists, to achieve the best standards of practice in ultrasound-guided biopsy procedures. ISUOG/ESGO nominated a multidisciplinary international group of 16 experts who have demonstrated leadership in the use of ultrasound-guided biopsy in the clinical management of patients with gynecological cancer. In addition, two early-career gynecological fellows were nominated to participate from the European Network of Young Gynae Oncologists (ENYGO) within ESGO and from ISUOG. The group also included a patient representative from the European Network of Gynaecological Cancer Advocacy Groups. The document is divided into six sections: (1) general recommendations; (2) image-guided biopsy (imaging guidance, sampling methods); (3) indications and contraindications; (4) technique; (5) reporting; and (6) training and quality assurance. To ensure that the statements are evidence-based, the current literature was reviewed and critically appraised. Preliminary statements were drafted based on this review of the literature. During a conference call, the whole group discussed each preliminary statement, and a first round of voting was carried out. The group achieved consensus on all 46 preliminary statements without the need for revision. These ISUOG/ESGO statements on ultrasound-guided biopsy in gynecological oncology, together with a summary of the evidence supporting each statement, are presented herein. This Consensus Statement is supplemented by detailed narrated videoclips presenting different approaches and indications for ultrasound-guided biopsy, a patient leaflet, and an extended version which includes a detailed review of the evidence. © 2025 The Authors. Published by John Wiley & Sons Ltd on behalf of The International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) and by Elsevier Inc. on behalf of the European Society of Gynaecological Oncology and the International Gynecologic Cancer Society.

Figure 1

Illustration of different approaches for performing core‐needle biopsy. (a,b) Transvaginal or transrectal approach: the biopsy device with biopsy needle is inserted into a metal needle guide attached to the endocavitary probe (a); the biopsy is taken from an infiltrated pelvic parietal (iliac) lymph node (b). (c,d) Percutaneous approach, using the free‐hand technique: the biopsy needle is inserted along the longitudinal axis of the probe, guided by the ultrasound beam (c); the biopsy is taken from the infiltrated abdominal wall (Sister Mary Joseph's nodule) (d). (e,f) Transcervical approach: using an ultrasound probe placed in the rectum or on the abdomen for guidance (e), the biopsy needle is visible approaching the lesion transcervically and transcavitarily (in‐organ biopsy) (f). UMT, uterine mesenchymal tumor. See also Videoclips [Link], [Link], [Link].

Figure 2

Illustration of core‐needle biopsy (CNB) mechanism, with a side‐cutting needle used to obtain biopsy sample. The tip of the biopsy needle should be positioned at the edge of or inside the lesion before firing, depending on the size of the lesion and the location of viable area(s) of tumor identified.

Figure 3

Comparison of fine‐needle aspiration (FNA) (a,b) and core‐needle biopsy (CNB) (c–e) specimens. (a) Macroscopic appearance of the cytological smear obtained from ascitic fluid (May–Grünwald–Giemsa stain) from a woman with findings suggestive of ovarian cancer and (b) high‐power view of carcinoma cells from the ascitic fluid (Papanicolaou stain). (c) Low‐power view of CNB specimen of the omentum (hematoxylin and eosin (H&E) staining) infiltrated by high‐grade serous carcinoma. (d) High‐power view of carcinoma cells with hyperchromatic and pleomorphic nuclei, and mitosis (H&E staining). (e) Immunohistochemical staining with p53 positivity in all cells, with strong and diffuse nuclear expression compatible with high‐grade serous carcinoma.

Figure 4

Instruments needed for core‐needle biopsy: (1) biopsy needle (30 cm/18 G); (2) needle guide for endocavitary probe; (3) sterile gel; (4) protective probe cover; (5) anesthetic gel; (6) analgesia suppository; (7) labeled specimen container; (8) basin, tongs and swabs for disinfection; (9) antiseptic cleaning agent; (10) sterile gloves; (11) automated core‐needle device; (12) needle and syringe for application of local anesthetic; (13) local anesthetic; (14) biopsy needle (20 cm/16 G); (15) needle guide for convex probe (optional); (16) wound covering. For transvaginal/transrectal biopsy procedure, instruments 1–11 are needed; for percutaneous biopsy procedure, instruments 3 and 7–16 are needed.