A biopsy is the only way to diagnose ovarian cancer. It involves taking a tissue sample from a tumor in the ovary and examining the cells under a microscope.
A doctor will use several tests and procedures to check for abnormalities in the ovaries that may suggest ovarian cancer. They will then order a biopsy to confirm whether the mass is cancerous.
In this article, we explain the role of a biopsy in diagnosing ovarian cancer. We also look at what to expect from an ovarian biopsy and the results of this test.
An ovarian biopsy involves a surgeon taking a small tissue sample from a tumor in the ovary. The ovaries are female reproductive organs that produce eggs. Ovarian cancer occurs when abnormal cell growth begins in the ovary. These cells grow and divide, forming a solid mass or tumor.
Doctors do not typically recommend stand-alone ovarian biopsies due to the risk of cancer cells breaking away from the primary tumor and spreading to the peritoneal cavity. The peritoneal cavity is the space in the abdomen that contains the stomach, intestines, and liver.
Instead, a biopsy will usually take place as part of a surgical procedure to remove all tissue that may be cancerous. A pathologist, a specialist in bodily tissues, will evaluate the tissue samples under a microscope to check for the presence and type of ovarian cancer.
If the tissue in the surrounding area is cancerous, a surgeon will remove as much of this tissue as possible.
They may also take some sample tissue from the surrounding organs and lymph nodes to determine whether cancer has spread, which is important in staging the disease.
People’s experience of an ovarian biopsy will vary, but the following information outlines what a person can generally expect.
Surgery
In most cases, an ovarian biopsy takes place during the removal of a tumor in a surgical procedure such as a laparotomy or a laparoscopy.
A laparotomy involves making a large abdominal incision, whereas a laparoscopy uses small incisions to access the abdomen with an instrument called a laparoscope. Both procedures happen under general anesthesia, which means that a person is in a sleep-like state in which they do not feel pain.
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A person may need to prepare for surgery by:
- avoiding eating for several hours before the procedure
- taking an enema to empty their bowels
- shaving any hair in the abdominal area
- stopping the use of certain medicines, such as blood thinners, temporarily
The surgery typically includes the removal of the:
- uterus
- fallopian tubes
- ovaries
- omentum, a fatty tissue layer covering the organs of the abdomen
Image-guided biopsy
In an image-guided biopsy, a doctor will use a CT scan or ultrasound to guide them on where to place a needle to take tissue samples from the ovaries or the omentum.
An anesthetist will inject a local anesthetic under the skin over the area where the doctor will insert the needle. The doctor may take samples from different sites, resulting in several puncture wounds. An image-guided biopsy may take a few minutes to an hour.
Image-guided biopsies
A rare complication of a type of image-guided biopsy called a fine needle aspiration is the risk of dragging cancer cells along the needle track incision, which may
However, there is currently little research on tumor cell seeding during ovarian biopsies. Researchers need to carry out further work to investigate this effect.
Paracentesis
If ovarian cancer causes ascites, which is a fluid buildup in the abdomen, a doctor can perform a paracentesis procedure to obtain a fluid sample to diagnose ovarian cancer.
After numbing the skin, the doctor will use a syringe with a 1–2-inch needle to pass through the abdominal wall into the fluid in the cavity. A CT scan or ultrasound will help them guide the needle, but they may sometimes need to create a small cut to ensure that the needle enters correctly.
A person can undergo this procedure, which typically takes about 20–30 minutes, in a doctor’s clinic or hospital.
Steps that a doctor may take before the procedure include:
- asking about allergies to numbing medications and latex
- checking current medications
- discussing any bleeding problems
- cleaning and shaving an area of the abdomen
- giving local anesthesia
A pathologist will examine the tissue samples that the surgeon gathers during a biopsy. They may be present during the surgery, or they might analyze the samples at a laboratory.
The results of a biopsy typically include the following information about the samples:
- a gross description of the sample, including its size, color, and appearance
- a microscopic description, including how the cells compare with healthy cells
- the type of surgical procedure to obtain the sample
- whether the cells are noncancerous or cancerous
- where cancer originated, which indicates the cancer type
- cancer grade, which describes how aggressive the cancer is
- tumor margin, which refers to whether the area surrounding the tumor contains cancer cells
- lymph nodes results, if the surgeon also took a sample from the nearby lymph nodes to check for cancer
- cancer stage
- diagnosis
- comments that can include a pathologist’s explanations and further recommendations
The results provide healthcare professionals with vital information about the cancer, including its stage and grade. This information helps them determine the best treatment approach.
An ovarian biopsy is an important stage in the diagnostic process to confirm ovarian cancer. There are several ways to take a biopsy, depending on a person’s health status and likely cancer stage.
A biopsy usually occurs during surgery, but doctors may sometimes do a biopsy using a needle to take tissue or fluid samples.
An ovarian biopsy is crucial in the diagnosis of ovarian cancer and the creation of a suitable treatment plan.