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Abstract
Objective
Ovarian needle aspiration and biopsy (ONAB) may be employed for pretreatment diagnosis of ovarian malignancies or intraoperatively to facilitate removal of ovarian masses. However, there is reluctance to utilize this procedure due to potential cyst rupture or seeding of malignant cells. The objective of this study was to examine the efficacy of ONAB over a 13-year period at our institution.
Methods
Between 2000 and 2013, all ONAB specimens were identified from the Queen's Medical Center Pathology Department database. All cytologic specimens were reviewed and correlated with histopathologic findings. A retrospective chart review was conducted to retrieve data on clinical course and treatment.
Results
This study identified 144 cases of ovarian masses sampled by aspiration or needle biopsy between 2000 and 2013. Ninety-two (64%) cases had corresponding histopathology, 84 (91%) of which were obtained concomitantly. On histology, 12 (13%) cases were malignant and 80 (87%) benign. Three false negative cases were noted; 2 serous borderline tumors and 1 mucinous cystadenocarcinoma. These were sampling errors; no diagnostic tumor cells were present in the aspirates. Sensitivity and specificity of ONAB in the detection of malignancy were 75% and 100%, respectively. The positive and negative predictive values were 100% and 96%, respectively.
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 | Fig. 2.Cytology of serous ovarian carcinoma with marked nuclear pleomorphism and prominent nucleoli (Diff-Quik, ×600). |
 | Fig. 3.Cytology of mucinous borderline tumor showing honeycomb tumor sheets in a background of abundant mucin (Diff-Quik, ×200). |
 | Fig. 4.Cytology of clear cell ovarian carcinoma: 3-dimensional tumor cluster with enlarged vesicular nuclei, prominent nucleoli, and abundant clear cytoplasm (Pap, ×1,000). |
 | Fig. 5.Cytology of endometrioid ovarian carcinoma with crowded overlapping clusters containing columnar tumor cells (Diff-Quik, ×400). |
 | Fig. 6.Cytology of granulosa cell tumor with Call-Exner bodies and intranuclear grooves (Diff-Quik, ×600). |
 | Fig. 7.Metastatic pulmonary adenocarcinoma showing pseudopapillary cluster with nuclear enlargement and cellular crowding (Diff-Quik, ×400). |
Table 1.
Ovarian needle aspiration/biopsy diagnosis and patient age (144 cases)
| Cytologic diagnosis | No. (%) of cases | Mean age (range) |
|---|---|---|
| Benign | 135 (94) | 41 (13–83) |
| Cyst | 134 (93) | 41 (13–83) |
| Infection | 1 (1) | 43 (43) |
| Malignant | 9 (6) | 54 (23–74) |
| Total | 144 (100) | 42 (13–83) |
Table 2.
Ovarian cytologic diagnosis by biopsy operator/clinician (144 cases)
| Operator | Total (%) | Benign | Malignant neoplasms | |
|---|---|---|---|---|
| Cyst | Infection | |||
| Gynecologist/surgeon | 126 (88) | 124 | 1 | 1 |
| Radiologist | 9 (6) | 1 | – | 8 |
| Other | 9 (6) | 9 | – | – |
| Total | 144 (100) | 134 | 1 | 9 |
Table 3.
Cytologic-histologic correlation of ovarian lesions (92 cases with corresponding histology)
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