Ovarian needle aspiration in the diagnosis and management of ovarian masses

Kimberly Nagamine; Jordan Kondo; Ricky Kaneshiro; Pamela Tauchi-Nishi; Keith Terada

doi:10.3802/jgo.2017.28.e40

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Nagamine, Kondo, Kaneshiro, Tauchi-Nishi, and Terada: Ovarian needle aspiration in the diagnosis and management of ovarian masses

Original Article

J Gynecol Oncol 2017;28(4):e40.

Published online: 4 July 2017

DOI: https://doi.org/10.3802/jgo.2017.28.e40

Ovarian needle aspiration in the diagnosis and management of ovarian masses

Kimberly Nagamine^1,, Jordan Kondo², Ricky Kaneshiro², Pamela Tauchi-Nishi^2,³, Keith Terada¹

¹Department of Obstetrics, Gynecology, and Women's Health, University of Hawaii, Honolulu, HI, USA

²Department of Pathology, The Queen's Medical Center, Honolulu, HI, USA

³Department of Pathology, University of Hawaii, Honolulu, HI, USA

Correspondence to Kimberly Nagamine Department of Obstetrics, Gynecology, and Women's Health, University of Hawaii, 1319 Punahou Street, Suite 824, Honolulu, HI 96826, USA. E-mail: kkmn@hawaii.edu

Received 4 November 2016 Revised 16 February 2017 Accepted 3 March 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Conclusion

ONAB represents a valuable tool in the diagnosis of malignancy and treatment of ovarian masses. In our study, it was highly specific, with excellent positive and negative predictive value.

Keywords: Needle Biopsy, Ovarian Neoplasms

References

1. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin. Management of adnexal masses. Obstet Gynecol. 2007; 110:201–14.

2. van Zante A, Ljung BM. Fine-needle aspiration versus core needle biopsy: reconsidering the evidence of superiority. Cancer. 2016; 124:853–6.

3. Cole L, Mount S, Nuzzo E, Wong C. Aspiration cytology of ovarian cystic masses: histologic correlation and review of the literature. Acta Cytol. 2011; 55:19–25.

4. Trimbos JB, Hacker NF. The case against aspirating ovarian cysts. Cancer. 1993; 72:828–31.

5. Moran O, Menczer J, Ben-Baruch G, Lipitz S, Goor E. Cytologic examination of ovarian cyst fluid for the distinction between benign and malignant tumors. Obstet Gynecol. 1993; 82:444–6.

6. Dordoni D, Zaglio S, Zucca S, Favalli G. The role of sonographically guided aspiration in the clinical management of ovarian cysts. J Ultrasound Med. 1993; 12:27–31.

7. Ganjei P, Dickinson B, Harrison T, Nassiri M, Lu Y. Aspiration cytology of neoplastic and non-neoplastic ovarian cysts: is it accurate? Int J Gynecol Pathol. 1996; 15:94–101.

8. Balat O, Sarac K, Sonmez S. Ultrasound guided aspiration of benign ovarian cysts: an alternative to surgery? Eur J Radiol. 1996; 22:136–7.

9. Caspi B, Goldchmit R, Zalel Y, Appelman Z, Insler V. Sonographically guided aspiration of ovarian cyst with simple appearance. J Ultrasound Med. 1996; 15:297–300.

10. Higgins RV, Matkins JF, Marroum MC. Comparison of fine-needle aspiration cytologic findings of ovarian cysts with ovarian histologic findings. Am J Obstet Gynecol. 1999; 180:550–3.

11. Allias F, Chanoz J, Blache G, Thivolet-Bejui F, Vancina S. Value of ultrasound-guided fine-needle aspiration in the management of ovarian and paraovarian cysts. Diagn Cytopathol. 2000; 22:70–80.

12. Martínez-Onsurbe P, Ruiz Villaespesa A, Sanz Anquela JM, Valenzuela Ruiz PL. Aspiration cytology of 147 adnexal cysts with histologic correlation. Acta Cytol. 2001; 45:941–7.

13. Roy M, Bhattacharya A, Roy A, Sanyal S, Sangal MK, Dasgupta S, et al. Fine needle aspiration cytology of ovarian neoplasms. J Cytol. 2003; 20:31–5.

14. Papathanasiou K, Giannoulis C, Dovas D, Tolikas A, Tantanasis T, Tzafettas JM. Fine needle aspiration cytology of the ovary: is it reliable? Clin Exp Obstet Gynecol. 2004; 31:191–3.

15. Hemalatha AL, Divya P, Mamatha R. Image-directed percutaneous FNAC of ovarian neoplasms. Indian J Pathol Microbiol. 2005; 48:305–9.

16. Uguz A, Ersoz C, Bolat F, Gokdemir A, Vardar MA. Fine needle aspiration cytology of ovarian lesions. Acta Cytol. 2005; 49:144–8.

17. Kadivar M, Karamvandi M. Fine needle aspiration cytology of ovarian lesions: Is it reliable? Asia Pac J Clin Oncol. 2008; 4:143–8.

18. Khan N, Afroz N, Aqil B, Khan T, Ahmad I. Neoplastic and nonneoplastic ovarian masses: diagnosis on cytology. J Cytol. 2009; 26:129–33.

19. Sood T, Handa U, Mohan H, Goel P. Evaluation of aspiration cytology of ovarian masses with histopathological correlation. Cytopathology. 2010; 21:176–85.

20. Mehdi G, Maheshwari V, Afzal S, Ansari HA, Ansari M. Image-guided fine-needle aspiration cytology of ovarian tumors: an assessment of diagnostic efficacy. J Cytol. 2010; 27:91–5.

21. Goel S, Agarwal D, Goel N, Naim M, Khan T. Ekrammulah. Ultrasound guided fine needle aspiration cytology in ovarian neoplasms: an assessment of diagnostic accuracy and efficacy and role in clinical management. Internet J Pathol. 2010; 11:1–6.

22. Gupta N, Rajwanshi A, Dhaliwal LK, Khandelwal N, Dey P, Srinivasan R, et al. Fine needle aspiration cytology in ovarian lesions: an institutional experience of 584 cases. Cytopathology. 2012; 23:300–7.

23. Bandyopadhyay A, Chakraborty J, Chowdhury AR, Bhattacharya A, Bhattachrya P, Chowdhury M. Fine needle aspiration cytology of ovarian tumors with histological correlation. J Cytol. 2012; 29:35–40.

24. Garady C, Boerner SL. Does cytological examination of ovarian cyst fluids obtained during oophorectomy add useful information? Mod Pathol. 2013; 26:A369.

25. Ray S, Gangopadhyay M, Bandyopadhyay A, Majumdar K, Chaudhury N. USG guided FNAC of ovarian mass lesions: a cyto-histopathological correlation, with emphasis on its role in pre-operative management guidelines. J Turk Ger Gynecol Assoc. 2014; 15:6–12.

26. Pal S, Chakrabarti S, Deuoghuria D, Phukan JP, Sinha A, Mondal PK. Evaluation of ultrasound-guided fine-needle aspiration cytology of ovarian masses with histopathological correlation. Acta Cytol. 2015; 59:149–55.

27. García-Tejedor A, Castellarnau M, Burdio F, Fernández E, Martí D, Pla MJ, et al. Ultrasound-guided aspiration of adnexal cysts with a low risk of malignancy: is it a recommendable option? J Ultrasound Med. 2015; 34:985–91.

Fig. 1.

Ovarian needle biopsy and cyst aspiration (2000–2013) with histologic follow-up.

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
Operator	Total (%)	Cyst	Infection	Malignant neoplasms
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)

Variables	Histologic diagnosis	Total	Cytologic diagnosis
Variables	Histologic diagnosis	Total	Benign	Malignant
Benign (n=80)	Benign cyst	19	19	0
	Endometriotic cyst	12	12	0
	Hydatid cyst of Morgagni	2	2	0
	Hydrosalpinx	3	3	0
	Mature cystic teratoma	10	10	0
	Serous cystadenoma	27	27	0
	Mucinous cystadenoma	7	7	0
Malignant (n=12)	Serous borderline tumor	2	2	0
	Mucinous borderline tumor	2	0	2
	Serous cystadenocarcinoma	2	0	2
	Mucinous cystadenocarcinoma	1	1	0
	Clear cell carcinoma	1	0	1
	Endometrioid carcinoma	1	0	1
	Granulosa cell tumor	1	0	1
	Metastatic lung adenocarcinoma	1	0	1
	Ovarian carcinoma NOS	1	0	1
Total		92	83	9

NOS, not otherwise specified.

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