Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
Cancer Cytopathol. 2018 Feb;126(2):112-121. doi: 10.1002/cncy.21911. Epub 2017 Aug 21.
Although ovarian fine-needle aspiration (FNA) cytology is not commonly used as a primary modality of diagnosis for patients with ovarian lesions, many ovarian cysts are aspirated intraoperatively and occasionally for diagnostic purposes. Therefore, the ability to interpret these specimens remains critical. Previous studies have suggested a high specificity but low sensitivity as a limitation. The objective of the current study was to further explore the use and performance of ovarian cyst FNA for diagnosing malignancy at the study institution.
The electronic database was searched from 1998 through 2016 for ovarian cyst fluid cytology specimens; any concurrent or follow-up surgical pathology; and clinical information including patient age, radiology findings, and procedure type. Test performance was calculated using the surgical pathology diagnosis as the gold standard.
A total of 459 ovarian cyst FNA specimens had the following diagnoses: 416 (90.6%) were diagnosed as benign, 32 (7.0%) as atypical, 4 (0.9%) as suspicious, and 7 (1.5%) as malignant. Overall, 300 specimens (65.4%) had a corresponding surgical pathology specimen. On follow-up, the rate of malignancy (including borderline neoplasms) for benign FNA was 10 of 264 specimens (3.8%), that for atypical FNA was 0 of 24 specimens (0%), that for suspicious FNA was 5 of 5 specimens (100%), and that for malignant FNA was 7 of 7 specimens (100%). Test sensitivity was 54.0% and test specificity was 100%. The positive predictive value was 1.00 and the negative predictive value was 0.97, with a disease (malignancy) prevalence of 7.33%.
Ovarian cyst fluid cytology is highly specific and moderately sensitive for the detection of ovarian malignancies. A negative FNA is reassuring for patients with a low pretest probability of malignancy. Cancer Cytopathol 2018;126:112-21. © 2017 American Cancer Society.
虽然卵巢细针抽吸细胞学（FNA）通常不作为卵巢病变患者的主要诊断方式，但许多卵巢囊肿在术中被抽吸，偶尔也用于诊断目的。因此，解读这些标本的能力仍然至关重要。先前的研究表明，其特异性高但敏感性低是一个局限性。本研究的目的是进一步探讨在本研究机构中使用卵巢囊肿 FNA 诊断恶性肿瘤的情况。
从 1998 年到 2016 年，在电子数据库中搜索卵巢囊液细胞学标本；任何并发或随访的手术病理；以及包括患者年龄、影像学发现和手术类型在内的临床信息。以手术病理诊断为金标准计算检测性能。
共 459 例卵巢囊肿 FNA 标本的诊断结果如下：416 例（90.6%）诊断为良性，32 例（7.0%）为非典型，4 例（0.9%）为可疑，7 例（1.5%）为恶性。总体而言，300 例标本（65.4%）有相应的手术病理标本。随访时，良性 FNA 的恶性肿瘤（包括交界性肿瘤）发生率为 264 例中的 10 例（3.8%），非典型 FNA 的 24 例中无一例（0%），可疑 FNA 的 5 例均为（100%），恶性 FNA 的 7 例均为（100%）。检测灵敏度为 54.0%，特异性为 100%。阳性预测值为 1.00，阴性预测值为 0.97，疾病（恶性肿瘤）患病率为 7.33%。
卵巢囊液细胞学对卵巢恶性肿瘤的检测具有高度特异性和中等敏感性。低术前恶性肿瘤概率患者的阴性 FNA 结果令人安心。癌症细胞病理学 2018;126:112-21. © 2017 美国癌症协会。
