Role of needle biopsy in the investigation of gynecologic malignancy.

Three methods were used to investigate and evaluate patients with primary and persistent/recurrent pelvic malignancy in the gynecologic oncology services at two medical centers. The 22-gauge Chiba needle was utilized with fluoroscopic guidance to perform fine needle aspiration (FNA) of pelvic and paraaortic lymph nodes that appeared abnormal on lymphangiography (LAG). The Tru-cut needle was used to obtain tissue samples from beneath the surface epithelium of the cervix, vaginal vault and parametrium. A disposable, hand-held syringe and 20-gauge needle were used to aspirate supraclavicular and inguinal lymph nodes and cul-de-sac nodules. One hundred thirty-eight patients were evaluated, with positive results in 66 (47.8%). Surgical exploration was used to further investigate 16 negative results that did not correlate with LAG and/or clinical presentation. The sensitivity and predictive value of a negative result for the three methods was Chiba needle FNA/LAG, 62.1% and 65.6%; Tru-cut needle biopsy, 94.4% and 93.5%; and hand-held syringe and needle, 87.5% and 66.7%, respectively. All three techniques proved to be safe, uncomplicated and rapid methods of assessing gynecologic tumor spread. Positive results from these techniques can often replace surgical exploration, with a considerable savings in patient morbidity and hospitalization, and permit additional treatment to proceed without delay. Negative results still require surgical validation.