THE VALUE OF CYST PUNCTURE IN THE DIFFERENTIAL-DIAGNOSIS OF BENIGN OVARIAN-TUMORS

A prospective collection of serum samples and ovarian cyst fluid was u sed to assess the use of different tumour markers and cyst fluid cytol ogy in combination with serum tumour markers for the differential diag nosis of benign ovarian cysts, A consecutive series of 108 women of me dian age 30 years (range 15-75) undergoing laparotomy or operative lap aroscopy for presumedly benign ovarian cyst(s) were studied at a teach ing hospital at the University of Milan, Italy, The main outcome measu res were tumour markers CA 125, CA 19.9 and carcino-embryonic antigen (CEA) in serum and ovarian cyst fluid, oestradiol and progesterone con centrations in cyst fluid, and cytology of the sediment, The studied c ysts were endometriotic (55 subjects), dermoid (16), mucinous (12), se rous (10) or of miscellaneous histotype (15, including four follicular and one luteal), Serum CA 125 concentrations were significantly highe r in the endometrioma patients than in the other groups, The sensitivi ty of CA 125 in the differentiation of endometriomas from other adnexa l tumours was 61.8% and the specificity 94.3%; combining CA 125 and CA 19.9 assays yielded a sensitivity of 83.6% and specificity of 62.3%, Cyst fluid tumour markers values were extremely scattered with ample o verlap between different cyst types, Oestradiol and progesterone conce ntrations were similar in the histological subgroups. Cyst fluid cytol ogy was non-specific, We concluded that the aspiration of fluid from p resumedly benign ovarian cysts appears to contribute little to the dif ferential diagnosis of various tumours, The use of combining serum CA 125 and CA 19.9 assays in the diagnosis of endometriomas needs further confirmation.