Aspiration cytology of ovarian cysts and cystic neoplasms. A study of 235 aspirates.

OBJECTIVE To assess the diagnostic value of aspiration cytology in individual cystic lesions of the ovary. STUDY DESIGN During a 42-month period, 235 cystic ovarian lesions were investigated by fine needle aspiration with cytologic examination (FNA). RESULTS Almost 56% (131/235) of the aspirates were devoid of diagnostic cells. The 104 diagnostic aspirates comprised 49 follicular cysts, 4 endometriotic cysts, 45 neoplastic lesions and 6 paraovarian/paratubal cysts. Cyst fluid estradiol (E2) content > 20 nmol/L identified an additional 43 follicular cysts. Histologic examination of the ovarian lesions with acellular cyst fluid containing low E2 revealed 2 corpus luteum hematomas, 1 atretic follicular cyst, 7 endometriotic cysts and 27 serous/mucinous epithelial tumors. The remaining 51 lesions were composed of other entities. Although the specificity of FNA for most nonfollicular cystic ovarian lesions approaches 100%, the sensitivity ranged from 36% for endometriotic cysts to 83% for proliferating/malignant serous tumors. CONCLUSION Prior to FNA of the ovary in an individual patient, consideration should be given to the likely diagnosis, the limitations of the technique and the high false negative rate for nonfollicular cystic lesions.