SELECTION OF CRITERIA FOR THE TREATMENT OF OVARIAN CYSTS ON THE BASESOF ULTRASOUND AND CYTOLOGY

The major objective of the present study was to determine whether leak age of ovarian cyst cells occurs when the cysts are punctured inside a container with saline. Other subjectives were to determine the sensit ivity and specificity of cytology in the differentiation between malig nant and benign cysts by comparing cytology data with histology data, and also to determine whether ultrasound call provide consistent evide nce for predicting whether the cyst is benign or malignant, thus permi tting the selection of patients with benign cysts for puncture rather than surgical exeresis. A cytologic study was carried out on the conte nts of 62 ovarian cysts diagnosed by ultrasound and clinical examinati on, and excised from 51 patients submitted to exploratory laparotomy. The cyst was excised and immersed in a container with saline outside t he surgical field. The cyst was punctured and its contents aspirated t hrough the wall of the container. Five samples were obtained for cytol ogy: (I) 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 submitt ed to centrifugation and slides of the precipitate were prepared for c ytology. 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 b etween the cytologic and histologic diagnoses (p<0.001). The sensivity 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 33% accuracy. The present results led us to conclude that cell leakage into physiological saline occurred after puncture and tha t cytologic study of cysts valuable in the diagnosis of benign and mal ignant processes.