Background: Ultrasound guided sampling techniques are frequently used in the tissue diagnosis of various tumours. Female patients commonly present with adnexal masses and require tissue diagnosis by trucut biopsy for initiation of the treatment. This study was done to determine the outcome of ultrasound guided trucut biopsy in patients presenting with suspected adnexal malignancy. Methodology: This cross sectional study was done at the Department of Radiology, MCH Centre, PIMS hospital, Islamabad from October 2018 to September 2020. In this study, all female patients aged 18 years and above with suspected adnexal malignancy were included. Trucut biopsy was performed under ultrasound guidance, sample sent for histopathology and various histopathological outcomes were assessed. Patients were kept under observation for 2 hours following biopsy. The data was entered and assessed by using SPSS version 24.0. Frequencies and percentages were calculated for nominal data and mean and standard deviation for numerical data. Results: Mean age of the subjects was 50.24±10.52 years and mean duration of symptoms was 2.97±1.23 months. Definitive diagnosis made in 59 (95.1%) out of 62 cases and only 3 (0.04%) cases were inconclusive; among which two showed inadequate sample and one showed normal tubo-ovarian tissue. 90% histopathological findings were conclusive and no complication was reported. Conclusion: Trucut biopsy has high diagnostic yield with no complications and most common malignancy detected was serous cystadenocarcinoma followed by mucinous carcinoma. Key words: Biopsy, Malignancy, Ultrasound