Ultrasound-guided Tru-cut Biopsy in Patients with Suspected Ovarian Cancer: Adequacy, Accuracy, Safety and Patient Assessment.

1. Current State of Knowledge

Ovarian cancer remains the most lethal gynecologic malignancy, largely due to the lack of early detection and its presentation at a late stage1,2. In patients with ovarian cancer, the most important prognostic factor is the absence of macroscopic tumor at the end of surgery as well as the histological type3. For this purpose, adequate imaging before surgery, as well as histological knowledge of the tumor before the application of neoadjuvant chemotherapy is of great essence. Ultrasound-guided or CT-guided tru-cut biopsy in patients with advanced ovarian cancer has slowly become the preferred method of histological verification over the last decade in patients with suspected advanced ovarian cancer, with prof. Fischerová and her team being the pioneers in its use4,5.

Our aim is to prospectively evaluate the role of ultrasound-guided tru-cut biopsy in the hands of an expert certified sonographer within a gynecological oncological center and with the material examined by a concrete expert in the gynecological oncological pathology field. The novelty in our approach so to say will lie in these three factors: prospective design, two expert sonographers, and one expert pathologist. This project will also be the first to include a patient experience survey after the procedure. Furthermore, with this project, we will be able to create a prospective database allowing for further work in the future. 2. Material Support for the Project

The ultrasound examination will be performed on the GE Voluson E10 system located in the gynecological oncology center, tru-cut biopsy will be performed using a fast-gun automated biopsy system for sampling with 16-18 Gauge tru-cut needle and a G/16-30 cm core-cut biopsy needle. Histological examination will be performed in the state of art Fingerland department of pathology. 3. Project Objectives

The goal of this project is to assess the adequacy of the material obtained from ultrasound-guided tru-cut biopsy for histopathological and immunohistochemical examination, compare for the accuracy of the histopathological diagnosis in samples with adequate material using the definitive surgical specimen as the reference standard while prospectively registering patient experience and complications after the procedure. 4. Methodology