Journal of Ultrasound in Medicine, Vol 10, Issue 1 9-14, Copyright © 1991 by American Institute of Ultrasound in Medicine

JOURNAL ARTICLE

Comparison of endovaginal ultrasound and cytological evaluation of cystic ovarian tumors

S. Granberg, A. Norstrom and M. Wikland
Department of Obstetrics and Gynecology, University Goteborg, Sweden.

Endovaginal ultrasound is a good diagnostic tool for distinguishing between cystic and solid tumors. Unilocular cysts in the lower pelvis seem to carry a very low risk of malignancy in women of all ages. Cytological evaluation of the fluid from a cystic ovarian tumor has rather poor accuracy in diagnosing malignancy. For such a reason, this study compares the diagnostic accuracy of endovaginal ultrasound to that of cytology of the cyst content. Furthermore, we wanted to determine whether irrigation after puncture of a cystic tumor could increase the number of cells in the fluid and thereby increase the diagnostic accuracy of the cytological evaluation. Fifty women admitted to surgery due to a cystic tumor were endovaginally scanned the day before surgery. After the intact tumor had been removed from the abdomen, its contents were aspirated by means of a double-channelled needle. Irrigation was performed with Ringer acetate. Cytological evaluation was performed on both portions of the cyst fluid. The negative predictive value with respect to malignancy was 77% for cytology of the first portion of the aspirate, 81% for irrigation, and 100% for ultrasound. The corresponding figures for positive predictive value were 100%, 100%, and 73%. We conclude that cytological evaluation after irrigation of a cystic ovarian tumor does not significantly increase accuracy in diagnosing malignancy compared to endovaginal ultrasound.

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