Limitations of the evaluation of adnexal masses by its macroscopic aspects, cytology and biopsy

To investigate the relevance of intraoperative macroscopic evaluation of ad nexal masses a prospective study was conducted from June 1st, 1993 to May 3 1st, 1994, which included 57 premenopausal and 60 postmenopausal women, who underwent laparotomy because of a cystic adnexal mass. The surgeons were a sked to classify the tumor intraoperatively as benign or malignant and to a ssign to histologic groups. In addition cytology of the cyst fluid and a bi opsy from the cystic wall were evaluated. Comparison of these items with th e results of permanent section diagnosis revealed the tendency of the surge ons to underestimate adnexal masses depending on patients' age and the comp lexity of the tumor, despite of the knowledge of preoperative ultrasonograp hic findings. Sufficient cytolologic examination was possible in only one t hird of aspirates and only 21% of the examined postmenopausal malignant neo plasms have correctly been diagnosed by cytology. Evaluation of the biopsy specimens demonstrates a marked percentage of false negatives with respect to benign tumors (30% of non-functional benign neoplasms in the premenopaus e were assessed as functional cysts) as well as malignant neoplasms (only 7 2% were diagnosed correctly in the postmenopause group). In conclusion intr aoperative subjective assessment, cytology and representative biopsies do n ot necessarily concur with the definitive histological diagnosis. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved.