Chemical analysis of adnexal cyst fluid

Objective. The purpose of the study was to determine if adnexal cyst fluid glucose, protein, and lactate dehydrogenase (LDH) levels can discriminate b etween cancerous and noncancerous adnexal masses. Methods. Intracystic fluid was aspirated from adnexal masses immediately af ter operative excision, Patient age and menopausal status, mass size, and c yst fluid specific gravity were recorded. Cyst fluid and intraoperative ser um glucose, protein, and LDH levels were measured. Masses were grouped by h istopathologic diagnosis. Cyst fluid chemical levels and cyst fluid/serum r atios were compared among and between the groups, Results. Fifty-eight adnexal masses were analyzed: 15 nonneoplastic (group 1), 23 benign neoplastic (group 2), and 20 malignant (group 3), There were no significant differences among the groups with regard to patient age, men opausal status, or cyst fluid specific gravity. Cyst size (cm(2)) was signi ficantly different among the three groups (P < 0.01), with the largest mean size found in the cancer group. No significant differences in cyst chemist ries or cyst fluid/ serum ratios were found between groups 1 and 2, Compari ng groups 1 and 3, all values were significantly different (P < 0.05), with the greatest level of significance attained by comparison of cyst fluid LD H levels (P < 0.001), Groups 2 and 3 statistically differed in cyst fluid l evels and cyst fluid/serum ratios of both protein and LDH, with the highest levels of significance achieved by comparisons of cyst fluid levels and ra tios of LDH (P = 0.001 and P < 0.001, respectively). The cyst fluid LDH lev el was found to be the best single chemistry for distinguishing noncancerou s (groups 1 and 2) from cancerous (group 3) adnexal masses. A cyst fluid LD H level of greater than or equal to 451 U/L imparted a 90% sensitivity and 71% specificity for detecting malignancy. Conclusions. Evaluation of adnexal cyst fluid LDH may help to distinguish b enign from malignant adnexal masses. More cases are needed to adequately as sess the predictive value and clinical utility of this approach.