THE ROLE OF SONOGRAPHICALLY GUIDED ASPIRATION IN THE CLINICAL MANAGEMENT OF OVARIAN CYSTS

This study was undertaken to verify the role of fine-needle aspiration (FNA) followed by cytologic examination as a possible alternative to surgery in case of cystic pelvic masses. From January 1988 to March 19 89, 204 patients with a proven cystic pelvic mass underwent FNA under sonographic guidance. In 20 cases the aspiration was performed transva ginally. Thirty-six patients were postmenopausal. In all cases the asp irated fluid was collected for cytologic evaluation. Other than one ca se of persistent hematuria, no complications occurred. The overall rec urrence rate, verified 3 months from FNA, was 65%. Fifty-two per cent of patients developed a new cyst after a complete aspiration. Fifty-th ree patients underwent a laparotomy, allowing a comparison between cyt ologic and histologic patterns. The sensitivity of cytologic examinati on of aspirated fluids was 40% (3 of 5 malignancies were missed) and t he specificity was 100% (no false positives were observed). We conclud e that FNA might be proposed in young women with a unilocular ovarian cyst to avoid a surgical procedure. In postmenopausal women with a uni locular cystic mass 5 cm or less, FNA may be considered as an importan t step in the diagnosis. In all instances the ultrasonographic appeara nce of the cyst (echo texture and regularity of wall) and the characte ristics of aspirated fluid are the most important findings. When the a spirated fluid contains mucus or blood, or when a complex mass is pres ent, exploratory laparotomy or a laparoscopy is recommended.