Comparison of fine-needle aspiration cytologic findings of ovarian cysts with ovarian histologic findings☆,☆☆

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Abstract

Objective: The purpose of this study was to compare cytologic findings of fluid from ovarian cysts with ovarian histologic findings. Study Design: Ovaries submitted for pathologic examination were grossly examined for ovarian cysts. Fluid was removed by needle aspiration from intact ovarian cysts and prepared for cytologic examination. The cytologic findings were categorized as benign, malignant, indeterminate, and nondiagnostic. Histologic classification was assigned using the guidelines established by the World Health Organization. A single pathologist evaluated each cytologic specimen and was blinded to the gross appearance and histologic findings of each ovary. Cytologic diagnoses were compared with the histologic diagnoses. Results: The study material consisted of 105 ovaries from 98 women. A comparison of the ovarian histologic findings with the cytologic diagnosis was performed in 89 of 105 cases. Histologic examination of the ovaries revealed 89 benign ovarian tumors and 13 ovarian carcinomas. The sensitivity of ovarian cyst cytologic evaluation was 25%, and the specificity was 90%. The false-positive rate for ovarian cytologic evaluation was 73%, and the false-negative rate was 12%. Conclusions: Cytologic examination of aspirated ovarian cyst fluid does not accurately predict ovarian histologic findings. (Am J Obstet Gynecol 1999;180:550-3.)

Section snippets

Material and methods

All ovaries submitted for pathologic examination at Carolinas Medical Center during a 1-year period were grossly examined for ovarian cysts by 1 of 5 pathologists at Carolinas Medical Center. These ovaries were submitted without fixation in formalin. Ovaries that ruptured during surgery were excluded from the study. Any intact ovary with an ovarian cyst or cysts 2 cm or larger was aspirated using a Cameco cytologic aspirator (Cameco, Sweden) with a 20-mL syringe and a 21-gauge needle. The

Results

One hundred five ovaries from 98 women constituted the study material. The average age of the women was 45 years (range 21-75 years). Ovaries were obtained at laparotomy in 82 patients, and 16 women underwent oophorectomy during laparoscopy. All ovaries were intact and contained at least 1 ovarian cyst. Initial evaluation of the cyst fluid revealed that one half of the specimens were relatively acellular.

Histologic examination of the ovaries revealed 89 benign ovarian tumors and 13 ovarian

Comment

Discovery of an asymptomatic ovarian cyst less than 5 to 6 cm in diameter can present a diagnostic dilemma for the clinician. In premenopausal women, many ovarian cysts this size are functional cysts that spontaneously resolve. Ovarian cysts in perimenopausal and menopausal women create more concern because of the increased incidence of ovarian cancer in this age group. Unfortunately, no 1 test or combination of tests has been shown to accurately predict ovarian histologic findings. Serum tumor

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