Objective <p>Ultrasound-guided transvaginal tru-cut biopsy is used for histological confirmation of ovarian malignancy in selected clinical settings. Although multiple cores are routinely obtained to improve diagnostic yield, the distribution of malignant tissue across cores obtained during a single biopsy session has not been systematically evaluated. This question is particularly relevant for translational workflows, such as tissue cryopreservation, where histological verification of each individual core is impractical. We present a prospective feasibility study evaluating intra-procedural concordance of malignant tissue across ultrasound-guided transvaginal tru-cut biopsy cores of ovarian lesions.</p> Results <p>Twenty-one patients undergoing ultrasound-guided transvaginal tru-cut biopsy of ovarian lesions were included in the final analysis. Tru-cut biopsy yielded a diagnostic result in 20 of 21 procedures (95.2%; Wilson 95% confidence interval 78.1%–99.4%). In all biopsy procedures in which malignant tissue was identified in at least one core, malignant tissue was consistently present in all other evaluable cores obtained during the same session, with no discordant cases observed. When tissue fragments were present, malignant tissue was also consistently identified in fragments whenever malignant tissue was present in cores. One procedure, involving a mucinous adenocarcinoma arising in the background of a borderline tumor, yielded no malignant in any submitted material. Overall, these findings demonstrate a high degree of intra-procedural concordance of malignant tissue across biopsy cores and support the feasibility of biopsy workflows relying on confirmation of malignant tissue in a single core.</p>