Value of ultrasound-guided fine-needle aspiration in the management of ovarian and paraovarian cysts

Abstract

This study was designed to assess if cytology was accurate for an appropriate diagnosis of ovarian and paraovarian cysts, and if the ultrasound-cytology-estradiol (UCE) triad was suffıcient to discriminate functional vs. nonfunctional cysts, the latter requiring surgical resection. One hundred twenty-two ultrasound-diagnosed adnexal cysts were punctured and surgically removed, and then subjected to cytologic and histologic examinations; 90 of these fluids were assayed for estradiol. Histologically, 30 cysts were functional and 92 were nonfunctional. A correct discrimination between functional and nonfunctional origin was obtained in 54.9% of cases with cytology, in 94.4% with estradiol assay, in 50.8% with ultrasonography, and in 97.8% with these three examinations combined (UCE triad). Among the 34 patients with no criteria of neoplastic origin (age Ͼ40, ultrasonographic findings), the UCE triad diagnosed six functional cysts. Therefore, 17.6% (6/34) of these young women could have avoided unnecessary surgery.Ovarian and paraovarian cysts are divided into two physiopathologic categories: functional and nonfunctional. The first kind of cyst is derived from abnormal folliculogenesis during sexual activity, and even in the absence of spontaneous regression, this kind does not require surgical resection, whereas the second kind, including true neoplasms and tumor-like lesions, is more frequent after age 40 and does require surgical removal because of potential malignant transformation. This study was performed 1) to define precise and reliable cytologic criteria for diagnosing ovarian and paraovarian cysts, 2) to assess the value of the ultrasoundcytology-estradiol (UCE) triad in discriminating functional from nonfunctional cysts, and 3) to determine indications and benefits of ultrasound-guided fine-needle puncture as a first-intention examination. Materials and Methods Patient SelectionDuring a 10-yr period, 119 women were investigated at the Department of Obstetrics and Gynecology of Roanne Hospital for a diagnosis of ovarian or paraovarian cyst(s) persisting after failure of a 3-mo hormonal therapeutic test. Every ovarian and paraovarian lesion with an ultrasonographic cystic component was included in the study. The age ranged from 10-92 yr (median, 38.7 yr). The main complaints were chronic pelvic pain and irregular bleeding. In 52 cases, the diagnosis was established during infertility investigation. Ultrasonography and Puncture ProcedureTransvaginal or transabdominal ultrasonographic examination was performed by gynecologists. Ultrasonographic criteria of nonfunctional origin were a size greater than 7 cm, multiple (Ͼ2) locules, irregularity of contour, echogenic content, thick septa, intra-or extracystic vegetations, and associated signs such as ascitis or lymph nodes. 1-3 The cysts were surgically removed by laparotomy or laparoscopy and submitted for cytologic and histologic examination, and for estradiol level measurement. The puncture was made with a 19-gauge needle, either by transabdominal or transvagi...

Performance of ovarian cyst fluid fine‐needle aspiration cytology

“…We also found a statistically significant difference in cyst size between benign and borderline/malignant lesions. Although size alone cannot be used to predict whether a cyst is benign, it can be used along with other radiological characteristics and clinical factors such as age, estradiol level, and CA 125 level when determining management. In addition, new tools are being developed to complement ovarian cyst FNA.…”

Cytopathology in Oncology

“…Clinical presentation and image studies may mimic pancreatic cancer. Islet 132 X. Lin and S. Komanduri cells may be present due to hyperplasia, which should not be misinterpreted as endocrine neoplasm. The features of FNA cytology are the presence of rare benign appearing or reactive ductal epithelial cells or no epithelial cells, macrophages, hemosiderin/ bile pigment, necrotic amorphous debris, inflammatory cells, calcification, fatty necrosis, cholesterol crystals, granulation tissue, and fibrous tissue (Fig.…”

“…Some clinicians have employed cytology in conjunction with other parameters, such as ultrasound findings and estradiol measurement to more selectively aspirate cystic lesions [130][131][132]. Therefore, if the practitioner wishes to use cytology in the work-up and treatment of adnexal masses, communication with the cytopathologist is advised to determine their level of experience with adnexal samples.…”