Selection of criteria for the treatment of ovarian cysts on the bases of ultrasound and cytology.

The major objective of the present study was to determine whether leakage of ovarian cyst cells occurs when the cysts are punctured inside a container with saline. Other subjectives were to determine the sensitivity and specificity of cytology in the differentiation between malignant and benign cysts by comparing cytology data with histology data, and also to determine whether ultrasound can provide consistent evidence for predicting whether the cyst is benign or malignant, thus permitting the selection of patients with benign cysts for puncture rather than surgical exeresis. A cytologic study was carried out on the contents of 62 ovarian cysts diagnosed by ultrasound and clinical examination, and excised from 51 patients submitted to exploratory laparotomy. The cyst was excised and immersed in a container with saline outside the surgical field. The cyst was punctured and its contents aspirated through the wall of the container. Five samples were obtained for cytology: (1) presurgical abdominal wash; (2) saline before cyst puncture; (3) fluid from the punctured cyst; (4) saline after cyst puncture, and (5) postoperative abdominal wash. The materials obtained were submitted to centrifugation and slides of the precipitate were prepared for cytology. A total of 248 slides were studied. Slides of cysts with good cellularity were stained with silver to study the nucleolar organizer regions. Analysis using Kappa statistics showed excellent agreement between the cytologic and histologic diagnoses (p < 0.001). The sensitivity of the cytologic study of the cyst was 75% and the specificity 100%, with a positive predictive value of 100%, a negative predictive value of 92%, and 93% accuracy. The present results led us to conclude that cell leakage into physiological saline occurred after puncture and that cytologic study of cysts valuable in the diagnosis of benign and malignant processes.