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.

Academic Unit of Obstetrics and Gynecology Hospital Polyclinic San Martino and University of Genoa Genoa Italy

Clinic of Surgical Oncology Faculty of Health Sciences with the Institute of Maritime and Tropical Medicine Medical University of Gdansk Gdansk Poland

Department of Cardiovascular Diseases University Hospitals Leuven Leuven Belgium

Department of Clinical Science and Education Karolinska Institutet Södersjukhuset Stockholm Sweden

Department of Development and Regeneration KU Leuven Leuven Belgium

Department of Gynaecological Oncology KK Women's and Children's Hospital Singapore

Department of Gynaecology National Institute of Oncology Budapest Hungary

Department of Gynecological Oncology Pomeranian Hospitals Gdynia Poland

Department of Gynecology Obstetrics and Neonatology 1st Faculty of Medicine Charles University and General University Hospital Prague Prague Czech Republic

Department of Pathology 1st Faculty of Medicine Charles University and General University Hospital Prague Prague Czech Republic

Doctoral School of Clinical Medicine University of Szeged Szeged Hungary

EGA Institute for Women's Health University College London London UK

Gemelli Women Health Center for Digital and Personalized Medicine Dipartimento Scienze della Vita e Sanità Pubblica Università Cattolica del Sacro Cuore Rome Italy

Gynecologic Oncology Service Nairi Medical Center National Institute of Health Yerevan Armenia

Hospital QuirónSalud Málaga Spain

iNOVA4Health NOVA Medical School Faculdade de Ciências Médicas NMS FCM Universidade NOVA de Lisboa Lisbon Portugal

Institut Bergonie Bordeaux France

Instituto Portugues de Oncologia de Lisboa Francisco Gentil Lisbon Portugal

Mohn Medical Imaging and Visualization Centre Department of Radiology Haukeland University Hospital Bergen Norway

Section for Radiology Department of Clinical Medicine University of Bergen Bergen Norway

Unità Operativa di Chirurgia dei Organi Genitali Esterni Femminili Divisione di Ginecologia Oncologica Dipartimento Scienze della Salute della Donna del Bambino e di Sanità Pubblica Fondazione Policlinico Universitario A Gemelli IRCCS Rome Italy

University of Navarra Pamplona Spain

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