Ultrasound‐guided fine needle aspiration of ovarian masses: Assessment of diagnostic accuracy and risk stratification using a categorical reporting system

Abstract

Introduction The present study was undertaken to assess the accuracy of fine needle aspiration cytology (FNAC) and cell‐block immunocytochemistry, and to estimate the risk of malignancy, using a categorical reporting system, in the diagnosis of ovarian masses. Methods This was a 5‐year retrospective study of FNAs of ovarian masses. The cytological diagnoses were categorised as inadequate, non‐neoplastic, benign neoplasms, indeterminate for malignancy, suspicious for malignancy and malignant neoplasms. The cytology was correlated with the corresponding histopathology to assess the diagnostic accuracy and risk of malignancy associated with each diagnostic category. Results Of a total of 66 703 FNAs performed during the study period, 580 (0.9%) were performed on ovarian masses. Of these, 40 (6.9%) were reported as non‐neoplastic; 76 (13.1%) as benign neoplasms; 14 (2.4%) as indeterminate for malignancy, 48 (8.3%) as suspicious for malignancy, 337 (58.1%) as malignant neoplasms and 65 (11.2%) as inadequate for interpretation. Immunocytochemistry (ICC) was performed on 99 (17%) aspirates. Subsequent histopathology was available in 208 (35.8%) cases. On cyto‐histopathological correlation, 183 (88%) were concordant and 25 (12%) were discordant. The overall sensitivity, specificity, positive and negative predictive values and diagnostic accuracy for diagnosing ovarian malignancy were 88.4%, 85.7%, 96.8%, 60.0% and 88% respectively. Risk of malignancy for each category was 80%, 0%, 4.5%, 66.7%, 88.5% and 98.5% respectively. Conclusions Ultrasound‐guided FNAC has high specificity and diagnostic accuracy for preoperative diagnosis of ovarian malignancies and hence is a valid diagnostic procedure in certain clinical situations. Reporting using a categorical system imparts uniformity and also provides the clinicians with an associated risk of malignancy to guide further management.

A sub‐hepatic nodule in a young female: Chase the case

“…The cytologic features of ovarian tumours, especially the SLCTs, are rarely described in the literature 2–6 . The cytology smears from SLCTs generally show two populations of cells.…”

“…The list of cytologic mimics expands further in aspirations from the metastatic sites, especially when the primary tumour type is not known. A thorough knowledge of the cardinal cytomorphologic features and a panel of immunochemical markers is invaluable in such situations 2,3,7,8 . The well‐differentiated SLCTs show immunopositivity for steroidogenic factor‐1 (SF1), FOXL2, vimentin, inhibin, calretinin and WT1.…”

Cytodiagnosis of bilateral abdominopelvic masses in a postmenopausal woman

“…Some of these cohesive papillary clusters may show central psammomatous calcification. Mitoses and necrosis are rarely seen 5 …”

“…Mitoses and necrosis are rarely seen. 5 The most common cytomorphological differential diagnoses include serous borderline tumour (SBT) and high-grade serous carcinoma (HGSC). The tumour cells in SBT show a similar arrangement as in LGSC; however, the degree of nuclear pleomorphism in the former is minimal.…”