Gupta N, Rajwanshi A, Dhaliwal L K, Khandelwal N, Dey P, Srinivasan R, Nijhawan R
Department of Cytopathology and Gynaecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
Cytopathology. 2012 Oct;23(5):300-7. doi: 10.1111/j.1365-2303.2011.00896.x. Epub 2011 Aug 25.
To assess the diagnostic value of fine needle aspiration cytology (FNAC) in ovarian lesions.
This was a retrospective study of ultrasound-guided (US) FNAC of 584 ovarian lesions from January 1998 to July 2010. The lesions were categorized into non-neoplastic lesions, neoplastic lesions and inadequate aspirates. The results were compared with the corresponding histopathology whenever available.
Of the 584 lesions, 180 (30.8%) were reported as non-neoplastic (48 non-specific inflammation, 11 tuberculosis, 63 functional cysts and 58 endometriotic cysts), 249 (42.6%) as neoplastic (81 benign lesions/tumours and 168 malignant) and 155 (26.5%) as inadequate. Based on the subsequent histopathology, which was available in 121 (20.7%), the cases were divided into those that were concordant and discordant. Concordant cases comprised 92/121 (76%), including 28 non-neoplastic lesions (seven non-specific inflammation, nine functional cysts and 12 endometriotic cysts), 42 surface epithelial tumours (13 benign and 29 malignant), 10 germ cell tumours (five mature cystic teratomas and five mixed germ cell tumours), seven sex-cord stromal tumours (three granulosa cell tumours, one sclerosing stromal tumour, one strümal leutoma, one Sertoli Leydig cell tumour and one malignant Sertoli cell tumour) and five miscellaneous lesions (one plasma cell tumour, two leiomyosarcomas and two cases of necrosis). Discordant cases comprised 29/121 (24%) (21were inconclusive or inadequate on cytology), including four endometriotic cysts, 14 surface epithelial tumours (one cystadenofibroma, one borderline mucinous tumour and 12 carcinomas), five germ cell tumours (two immature teratomas and three mature cystic teratomas), two thecomas, one fibroma, one sclerosing stromal tumour, one fibrosarcoma and one myxoma. FNAC sensitivity for a diagnosis of malignancy was 85.7%, specificity 98.0%, positive predictive value 97.7%, negative predictive value 87.7% and accuracy 92.0%, if 21 inconclusive/inadequate FNACs were excluded; with the latter taken as false negatives, sensitivity was 73.7% and accuracy 76.0%.
FNAC has a high specificity for diagnosis of ovarian/adnexal lesions but greater experience is required for the accurate subtyping of neoplasms and sensitivity is limited by inconclusive/inadequate results.
评估细针穿刺细胞学检查（FNAC）在卵巢病变中的诊断价值。
这是一项对1998年1月至2010年7月间584例卵巢病变进行超声引导下（US）FNAC的回顾性研究。病变分为非肿瘤性病变、肿瘤性病变和穿刺不充分。结果尽可能与相应的组织病理学结果进行比较。
584例病变中，180例（30.8%）报告为非肿瘤性（48例非特异性炎症、11例结核、63例功能性囊肿和58例子宫内膜异位囊肿），249例（42.6%）为肿瘤性（81例良性病变/肿瘤和168例恶性病变），155例（26.5%）穿刺不充分。根据随后可获得的121例（20.7%）组织病理学结果，病例分为一致和不一致两类。一致病例包括92/121（76%），其中28例非肿瘤性病变（7例非特异性炎症、9例功能性囊肿和12例子宫内膜异位囊肿），42例表面上皮肿瘤（13例良性和29例恶性），10例生殖细胞肿瘤（5例成熟囊性畸胎瘤和5例混合性生殖细胞肿瘤），7例性索间质肿瘤（3例颗粒细胞瘤、1例硬化性间质瘤、1例stromal黄体瘤、1例支持-莱迪希细胞瘤和1例恶性支持细胞瘤）和5例其他病变（1例浆细胞瘤、2例平滑肌肉瘤和2例坏死病例）。不一致病例包括29/121（24%）（21例细胞学检查结果不确定或不充分），其中4例子宫内膜异位囊肿，14例表面上皮肿瘤（1例囊腺纤维瘤、1例交界性黏液性肿瘤和12例癌），5例生殖细胞肿瘤（2例未成熟畸胎瘤和3例成熟囊性畸胎瘤），2例卵泡膜瘤，1例纤维瘤，1例硬化性间质瘤，1例纤维肉瘤和1例黏液瘤。如果排除21例不确定/不充分的FNAC，FNAC诊断恶性肿瘤的敏感性为85.7%，特异性为98.0%，阳性预测值为97.7%，阴性预测值为87.7%，准确性为92.0%；将后者视为假阴性，则敏感性为73.7%，准确性为76.0%。
FNAC对卵巢/附件病变的诊断具有较高的特异性，但对肿瘤进行准确亚型分类需要更多经验，且敏感性受不确定/不充分结果的限制。
