Correlation of Aspiration Cytology of Ovarian Cystic Masses with Histology
L Cole, S Mount, E Nuzzo, C Wong. University of Vermont, Burlington, VT
Background: There is conflicting evidence regarding the diagnostic accuracy of cytological evaluation of ovarian cystic lesions with sensitivities ranging from 25-76% and specificities from 97-100%. The purpose of this study was to evaluate the accuracy of aspiration cytology of ovarian cystic masses and to identify pertinent clinical and radiologic parameters of both benign and malignant lesions.
Design: Following IRB approval, 67 cases were identified to have FNA of an ovarian cystic mass followed by a cystectomy/oophorectomy. All cases were performed and evaluated at Fletcher Allen Health Care from 2000-2007. Radiographic and clinical data were obtained from chart review. Histologic diagnosis was used as the definitive standard upon which correlation with the five parameters of cytologic diagnosis, radiographic size (>5cm or >10cm), architectural complexity, and serum CA125 level (>35 U/ml) was made. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Chi square (x2) analyses for the tests of significance and independence were calculated.
Results: Ten of the 67 cases were malignant, including 2 metastatic neoplasms and 5 borderline tumors. Of the 10 malignant cases, 5 were atypical/malignant and 3 non-diagnostic/paucicellular on cytologic assessment. The five parameters were independent of one another and correlation with malignancy was found not to be significant.
*if X20.95(1)3.84, then significant association and p<0.05
|CA125 >35 U/ml||70%||85%||54%||92%||0.25||>0.05|
|Size >5 cm||90%||35%||21%||95%||0.039||>0.05|
|Size >10 cm||80%||77%||40%||95%||0.2||>0.05|
Conclusions: Reasons for the low sensitivity (50%) of cytology were the paucicellular nature of aspirate (n=3), focality of ovarian borderline tumors (n=5), and surface involvement by metastatic cancer (n=2). If only primary ovarian malignancies were evaluated, (n=8), the sensitivity of cytology would have been 63%. Cytology in this series, however, was the only parameter with 100% specificity and 100% PPV. As there may be a trend for the use of neoadjuvant chemotherapy in the treatment of ovarian malignancy, it is imperative to evaluate the accuracy and reliability of FNA of the ovary.
Wednesday, March 11, 2009 1:00 PM
Poster Session VI # 62, Wednesday Afternoon