Objectives
Women with undiagnosed pelvic lesions are often referred for evaluation and treatment. Transvaginal ultrasound‐guided fine needle aspiration (TVUS‐FNA) biopsy can assist in making management decisions. We describe our experience with this modality.

Methods
We performed a retrospective chart review of all women who had a TVUS‐FNA biopsy between January 2004 and December 2014. Charts were reviewed for clinicopathologic information. The pathologic results of the TVUS‐FNA were compared with the final diagnosis.

Results
Fifty‐nine women underwent TVUS‐FNA; the median age was 66 years (range 27–85). Thirty‐three lesions were evaluated by fine‐needle aspiration biopsy of the solid structure and 26 by aspiration of fluid for cytology. Pathologic feasibility rate was 88% (52/59). Of those with evaluable tissue, the sensitivity of the procedure was 100% and the specificity 92%. Considering the seven inconclusive results, the procedure had sensitivity of 88% (29/33) and specificity of 88% (23/26). Overall accuracy of TVUS‐FNA for this patient cohort was 85%. No patient characteristics were found to distinguish between accurate and inaccurate or inconclusive TVUS‐FNA result. No complications were noted.

Conclusions
TVUS‐FNA offers an excellent modality for the diagnosis and management of deep pelvic lesions otherwise not amenable for histologic evaluation.