Early and short-term complications after US-guided puncture of gynecologic lesions: evaluation after 1,000 consecutive cases

Co-Existence of Endometriosis with Ovarian Dermoid Cysts: A Retrospective Cohort Study

Both endometriosis and ovarian dermoid cysts are benign conditions characterized by the presence of well-differentiated tissues in ectopic locations. The presence and surgical excision of these entities can potentially impact ovarian reserves, contributing to reduced chances of future pregnancy. The objective of our study is to investigate the bidirectional association between endometriosis and ovarian dermoid cysts, as well as to analyze the clinical characteristics of patients diagnosed with both conditions. A retrospective cohort study was conducted, including women who underwent laparoscopy and received histological diagnoses of endometriosis and/or dermoid cysts between 2011 and 2019 at the Cantonal Hospital of Schaffhausen. We identified 985 women with endometriosis and 83 women with ovarian dermoid cysts. Among these groups, 22 women presented with both endometriosis and ovarian dermoid cysts. The majority of the above patients had endometriosis stage rASRM I-II (72.7%), with peritoneal endometriosis being the most common phenotype of endometriosis (77.2%). Out of the 14 patients with a desire for future pregnancy, the majority (11/14, 78.5%) had an EFI score of 7-8. The prevalence of bilateral ovarian dermoid cysts was higher in women with both ovarian dermoid cysts and endometriosis in comparison to women with ovarian dermoid cysts without endometriosis (18% vs. 6.5%). Our study revealed that 26.5% of women with ovarian dermoid cysts also had endometriosis, a notably higher prevalence than observed in the general population. Clinicians should be aware of this co-existence, and preoperative counseling should be an integral part of the care plan for affected individuals, where the potential risks and the available options for fertility preservation should be discussed in detail.

Ultrasound-guided transvaginal biopsies of pelvic lesions: diagnostic yield, safety profile, and technical considerations over a 20-year experience

PURPOSE

To evaluate diagnostic yield, safety profile, and specific technical considerations of transvaginal ultrasound (TVUS) guided biopsy/aspiration.

MATERIALS/METHODS

TVUS guided biopsy (core, FNA) procedures with pre-procedure CT/MRI imaging at a single institution between 2001 and 2021 were reviewed. Relevant patient demographic data was extracted via the Electronic Health Record (EMR), technical details of the biopsy procedure were collected, and distance to target via transvaginal and transabdominal biopsy approach was measured on pre-procedure imaging. Surgical pathology was reviewed and assessed for concordance. Complications were assessed. Statistical analysis was performed using SPSS.

RESULTS

96 TVUS procedures (mean age, 58.7 ± 15.2 years; mean BMI, 27.4) were reviewed. TVUS guided approach decreased the distance to target (mean, 1.1 cm vs 8.6 cm transabdominal; p < 0.0001) and created a safe path not otherwise available in two patients. Average lesion size was 4.0 ± 2.1 cm (IQR 2.5, 5.2 cm) and targets at or above the vaginal cuff (0.9 ± 1.5 cm) and up to 0.5 ± 1.0 cm above the acetabular roof were accessible. 75 (78%) cases were core biopsies (18G; median, 2 passes) and 21 were FNA. Conscious sedation was used in 84.4% (n = 81) of cases and local anesthetic was also used in 84.4% (n = 81) of cases. Overall diagnostic yield was 98.9% (n = 94) with 94.7% (n = 89) cases confirmed as concordant diagnoses, including 57.4% (n = 54) malignant. Complications occurred in eight patients (8.3%), all minor. No post-biopsy infections were encountered regardless of administration of pre-procedure antibiotics (n = 14, 14.6%,), documentation of sterile prep (n = 92, 95.8%), or speculum use (n = 19, 19.8%). 50% (n = 48) had a prior hysterectomy, with no association with adequacy or complications (p = 0.9).

CONCLUSION

Transvaginal biopsy of pelvic lesions offers excellent diagnostic yield and favorable safety profile, and can dramatically decrease distance to target.

CLINICAL RELEVANCE

Ultrasound-guided transvaginal approach offers a safe and effective way to biopsy pelvic lesions in women.

Ultrasound-guided biopsy of challenging abdominopelvic targets

Percutaneous ultrasound-guided biopsies have become the standard of practice for tissue diagnosis in the abdomen and pelvis for many sites including liver, kidney, abdominal wall, and peripheral nodal stations. Additional targets may appear difficult or impossible to safely biopsy by ultrasound due to interposed bowel loops/vasculature, deep positioning, association with the bowel, or concern for poor visibility; however, by optimizing technique, it is often possible to safely and efficiently use real-time ultrasound guidance for sampling targets that normally would be considered only appropriate for CT guided or surgical/endoscopic biopsy.

Conservative treatment versus surgical excision of ovarian dermoid cysts: Impact on ovarian stimulation and IVF cycle success

OBJECTIVE

To analyze outcomes of IVF treatment among women diagnosed with an ovarian dermoid cyst (DC).

METHODS

Retrospective analysis of women with an ovarian DC who underwent IVF with fresh blastocyst transfer at a single center in New York from January 2010 to March 2018. Outcomes were compared between women with conservative treatment and those with surgical excision of the DC. Multivariate logistic regression was used to assess associations between variables and the presence of a DC during treatment.

RESULTS

Overall, 119 women with a DC were included. No differences were found in demographic characteristics, controlled ovarian hyperstimulation parameters, and IVF outcomes between women with an intact DC (n=65, 54.6%) and those who underwent cystectomy (n=54, 45.4%) (all P<0.05). Similarly, there was no difference in anti-Mϋllerian hormone and basal antral follicle count among women with a DC (respectively, β=-0.1, P=0.8, and β=-1.0, P=0.28) or resected DC (respectively, β=0.9, P=0.07, and β=1.5, P=0.08) as compared with control women with no DC (n=352).

CONCLUSION

Ovarian reserve, embryo implantation and IVF success rates were not lower in the presence of an ovarian DC. Surgical therapy, if indicated, can be safely postponed until family planning goals have been achieved.

Fine-Needle Aspiration Biopsies of Ovarian Masses: A Reliable Technique

OBJECTIVE

In gynecology, fine-needle aspiration (FNA) has an overall accuracy of 94.5% in differentiation between benign and malignant tumors. The purpose of this study was to determine reliable cytological criteria for categorizing ovarian masses into benign and malignant categories, their subtypes, and also to evaluate FNA accuracy in the diagnosis of ovarian tumors in relation to histopathological findings.

STUDY DESIGN

A prospective study was performed on all patients with a preoperative diagnosis of ovarian tumor who were referred to our hospital between August 2013 and August 2015. During surgery, FNA was performed using an 18-gauge needle by a pathologist. Aspirated material was spread on clean glass slides and stained with Papanicolaou and Wright-Giemsa stains. The cytological findings and results were compared with the histological diagnosis.

RESULTS

Of the 81 cases in this study, there was a discrepancy between the cytological and histological diagnosis in 9 cases. The overall cytological diagnostic accuracy in our study was 88.9% with a sensitivity and specificity of 78.1 and 95.5%, respectively.

CONCLUSION

FNA of an ovarian mass is a minimally invasive procedure with acceptable diagnostic accuracy, especially when differentiating between benign and malignant lesions, and can be considered as a useful diagnostic modality for choosing an appropriate management course.

Management of ovarian cysts with percutaneous aspiration and methotrexate injection

Background:

To evaluate ultrasonographic-guided cyst aspiration and methotrexate injection in the management of simple and endometriotic ovarian cysts in selected patients.

Subjects and Methods:

This prospective study was conducted in the Department of Obstetrics and Gynaecology in Government Medical College and Hospital, Chandigarh, from November 2007 to October 2009. It included 132 female patients (age range, 15–72 years; mean, 38.7 years) with simple or endometriotic ovarian cysts (3.0–10.6 cm) at ultrasonic examinations. We performed puncture and aspiration followed by methotrexate injection into the cyst. All patients were followed for 12 months. None was lost to follow-up.

Results:

At follow-up ultrasonography, cysts had disappeared in 120 patients (90.90%) and persisted in 12 patients (9%). No major complications were observed in our study population during or after the procedure. Only 10 patients reported mild pelvic pain, and four others reported dizziness or nausea during or after the procedure. Malignant cells were not found in any of the cases at cytologic examination. We did not observe any cases of infection after the procedure.

Conclusion:

Ultrasonography-guided transabdominal aspiration of cyst fluid and subsequent methotrexate injection appears to be an alternative treatment for both simple and endometriotic ovarian cysts in selected cases.

USG guided FNAC of ovarian mass lesions: A cyto-histopathological correlation, with emphasis on its role in pre-operative management guidelines

OBJECTIVE

Ultrasonography (USG)-guided fine-needle aspiration cytology (FNAC) of ovarian masses is an efficient diagnostic modality for accurately diagnosing ovarian tumours prior to surgery. The main aim of this study was to assess the sensitivity, specificity and accuracy of FNAC in diagnosing ovarian masses.

MATERIAL AND METHODS

Eighty-three patients with ovarian masses were recruited and correlation of USG-guided FNAC was made with histopathology in all but 6 cases, where surgery was not indicated.

RESULTS

Cytological diagnosis was obtained in all 83 ovarian lesions: 56 cases were benign, 6 possibly benign, 3 suspicious of malignancy and 18 cases as malignant. Out of 77 cases where histology was available, the 12 non-neoplastic cysts were endometriotic cysts and follicular cysts. The majority of neoplastic lesions were surface epithelial tumours. Out of 12 non-neoplastic cysts and 43 benign tumours, all but two were diagnosed as benign or possibly benign on cytology; of the 22 histologically malignant or borderline tumours, 18 were malignant or suspicious of malignancy on cytology, while four were false negative (three of these were borderline tumours). Thus, the sensitivity of cytological diagnosis was 83%, specificity was 97% and accuracy was 93%.

CONCLUSION

USG-guided FNAC seems to be a relatively safe, simple, fast and cost-effective procedure where most ovarian malignancies either present late in their course or no screening method is available. In addition, cyto-radiological correlation through this procedure may be useful in deciding management guidelines prior to any surgical intervention.

Impact of intracystic ethanol instillation on ovarian cyst diameter and adjacent ovarian tissue

OBJECTIVE

To investigate the regression level of simple ovarian cyst size after local ethanol application and the damage level of adjacent ovarian reserve in rats.

STUDY DESIGN

This study was conducted at Firat University Animal Laboratory with 18 mature (12-14 weeks old) female Wistar albino rats weighing 200-220g, with regular cycles. Ovarian cyst induction was performed with unilateral salpingectomy. Fourteen rats with ovarian cysts after a second laparotomy were divided into two groups as follows: Group 1 (n=7): cyst aspiration group, and Group 2 (n=7): intracystic 95% ethanol application group. One month after the cyst aspiration procedure a third laparotomy was performed. The cyst number and size were recorded for each rat. Right ovariectomy was performed and formalin-fixed/paraffin-embedded tissues were sectioned at 5μm thickness. Under light microscopy, ovarian total follicle reserve and fibrosis were evaluated with Masson trichrome staining and apoptosis was evaluated with TUNEL staining. The groups were compared with the Mann-Whitney U test and Wilcoxon Rank test. p<0.05 was considered significant.

RESULTS

Ovarian cyst formation was observed in 85% (15/18) of rats. The mean diameter of ovarian cysts in Groups 1 and 2 were, respectively, 10.3mm and 10.1mm. After aspiration, there was no significant reduction in the cyst diameter (10.3mm vs 8.1mm), but after ethanol application the diameter significantly reduced (10.1mm vs 3.4mm, p<0.05). Mean ovarian follicle count in Group 2 was significantly lower than in Group 1 (25 vs 42, p<0.05), and mean fibrosis and apoptosis scores in Group 2 were significantly higher than in Group 1 (2.5 vs 0.9, p<0.05).

CONCLUSION

Local ethanol application reduces cyst diameter but concomitantly decreases ovarian reserve due to increased fibrosis in rats. In humans, intracystic ethanol application should be performed cautiously.

Management of pelvic lymphoceles after radical prostatectomy: a multicentre community based study

Introduction

Pelvic lymphoceles (LC) following radical prostatectomy (LC-RP) have an incidence up to 27%. LC-managements constitute 50% of surgical interventions performed in post-RP patients.

Objectives

To describe a therapeutic algorithm for LC-managements based on a community based representative retrospective study.

Patients and methods: Multicentre data from 304 patients with LC-RP were retrospectively examined for LC-managements. RPs were performed by various surgeons from 67 urological departments. All patients had undergone 3 weeks rehabilitation in a specialized hospital where the data base was generated. Indications and results of therapeutic manoeuvres were used to develop a general concept for planning therapy decisions.

Results

Median age was 64 years. Complications occurred in 9% (28/304) of patients. Median LC-volume was 36 ml (range 20-1800 ml). There were more complications for LCs with ≥100 ml volume than those < 100 ml (27% versus 17%, p = 0.346). Conservative therapy was the standard in uncomplicated cases (87%, 239 of 276 patients), while intervention was done in 13% (puncture and/or drainage, surgery). Surgical intervention was performed significantly more often in complicated cases (82%, 23 from 28 patients; p < 0.001). Based on these data, LCs can be stratified into 3 groups depending on the size and clinical presentation. Therapeutic decisions were used to develop the illustrated new therapy algorithm.

Conclusions

This study based treatment algorithm provides a rationale approach with an accurate LC-classification as regard the indications and decision making for the available LC-RP-therapies. This could facilitate management decisions. Evaluation of this concept prospectively in large patient cohort is mandatory.

Modified laparoscopic lymphocele marsupialization for the treatment of lymphoceles after radical prostatectomy: first results

OBJECTIVES

The objective of this study was to describe a simple modification of the laparoscopic pelvic lymphocele marsupialization (LL) following radical prostatectomy lymphoceles (RP-LC).

PATIENTS AND METHODS

Forty-eight patients (57-76 years) with symptomatic RP-LC underwent surgery in our institute. This was through an open approach in 6 (open drainage [OL]) and LL in rest of the patients (12 with 3 [LL3] and 30 with 2 [LL2] trocars). All except 2 patients were refractory to percutaneous tube drainage and/or sclerotherapy. Pelvic ultrasound and/or computed tomography scans revealed LC size (4 × 5-11 × 12 cm) and volumes (100-1100 mL).

RESULTS

All surgeries were uneventful with an operative time of 15-60 minutes for LL and 35-90 minutes for OL and it became shorter with increasing experience with LL2 (15-25 minutes). Mean hospitalization time was 2.3 and 8 days after LL (LL2 and LL3) and OL, respectively. LC were at the right side in 10 patients, at the left side in 6, and at both sides in 14. Postoperative ultrasound revealed primary success in all cases. No patient developed recurrence of or had treatment for lymphocele during a mean follow-up time of 19 months.

CONCLUSION

LL2 is a simple, feasible, and safe procedure that could be used as a first-line treatment for large, noninfected symptomatic or refractive RP-LC.

Ovarian cysts during pregnancy: dilemmas in diagnosis and management

With routine obstetric ultrasound examinations, ovarian cysts are now more commonly diagnosed during pregnancy and their management is still a challenging clinical issue among obstetricians. The aim of this paper is to review the different management options of ovarian cysts detected during pregnancy, and it highlights the emergence of laparoscopic technique as a valuable therapeutic tool in these conditions. The review shows that conservative management and ultrasound follow-up is sufficient for the majority of cases of ovarian cysts during pregnancy. It also discusses the limitations of tumour markers during pregnancy, and the controversy around ultrasound-guided aspiration procedures. Emerging evidence suggests that if surgery is necessary, then it is preferable to perform an elective laparoscopic procedure at 16 - 23 weeks' gestation. It is time to consider establishing a UK registry to monitor the treatment offered to those women and to develop national guidelines to help in the management of this controversial issue.

Management of Ovarian Cysts with Aspiration and Methotrexate Injection

PURPOSE

To evaluate prospectively ultrasonography (US)-guided cyst aspiration and methotrexate injection in the management of simple and endometriotic ovarian cysts in selected patients.

MATERIALS AND METHODS

Authors obtained informed patient consent and approval from hospital ethics committee. Study included 162 female patients (aged 15-77 years) with simple or endometriotic ovarian cysts (3.0-10.6 cm) at a tertiary hospital. Criteria for inclusion in the study were (a) persistence of the cyst for at least 6 months, (b) benign appearance of the cyst at US, and (c) normal serum CA-125 level measurement before the procedure. Authors performed transabdominal aspiration of the cysts with direct US guidance and injection of methotrexate (30 mg). Cytologic examination was performed in all cases. Follow-up US was performed at 1, 3, and 6 months. If the cyst persisted, the procedure could be repeated. Main outcome measure was resolution or persistence of cysts. chi(2) Test or Mantel-Haentszel chi(2) tests for univariate analysis and multiple logistic regression were used for multivariate statistical analysis.

RESULTS

Of 162 patients, 148 were available for follow-up. Malignant cells were not found in any of the cases at cytologic examination. At follow-up US, cysts had disappeared in 124 patients (83.8%) and persisted in 24 (16.2%). Cyst diameter proved to be a significant prognostic factor for cyst resolution (P = .01). No major complications were observed. Patients received neither analgesia nor antibiotics.

CONCLUSION

US-guided transabdominal aspiration of cyst fluid and subsequent methotrexate injection appears to be an alternative treatment for both simple and endometriotic ovarian cysts in selected cases.

The incidence and treatment of lymphoceles after radical retropubic prostatectomy

OBJECTIVE

To determine the incidence and treatment of lymphoceles after retropubic radical prostatectomy (RP).

PATIENTS AND METHODS

Up to January 2004, 260 patients who had a retropubic RP in one institution by one surgeon were assessed retrospectively, using the patients' notes or the computerized results system to determine whether a lymphocele was suspected and then confirmed by imaging studies (computed tomography or ultrasonography).

RESULTS

Nine patients developed symptomatic lymphoceles; eight of these were detected by imaging. Four lymphoceles required intervention while the remainder regressed spontaneously. No complications were reported in the group that was treated.

CONCLUSION

The rate of symptomatic lymphocele formation was low after RP, with an overall incidence of 3.5%. Ultrasonography was effective in detecting lymphoceles and ultrasonographically guided percutaneous drainage an effective treatment.

Reproductive performance after ultrasound-guided transvaginal ethanol sclerotherapy for ovarian endometriotic cysts

OBJECTIVE

Ultrasound-guided transvaginal ethanol sclerotherapy (TV-EST) has been widely practised in Japan for ovarian endometriotic cysts. We investigated the possible adverse effects of TV-EST for ovarian endometriotic cysts on reproductive performance.

PATIENTS AND METHODS

We reviewed retrospectively medical records and compared clinical outcomes of 45 subfertile women who underwent TV-EST for ovarian endometriotic cysts (Study group) with those of 65 subfertile women without ovarian endometriotic cysts (Comparison group). Patients were followed up monthly for 24 months. Serum levels of LH, FSH, CA125 and CA19-9 were determined before and after TV-EST.

RESULTS

No complications associated with TV-EST were observed. There were no differences in the numbers of pregnancies (47% (21/45) versus 39% (25/65)), term deliveries (76% (16/21) versus 76% (19/25)), abortions (19% (4/21) versus 24% (6/25)), retrieved oocytes, or quality of embryos between the Study and Comparison groups, respectively. The serum levels of LH and FSH did not increase after TV-EST. The serum levels of CA125 and CA19-9 did not significantly decrease after TV-EST. Ovarian cysts recurred in six (13.3%) of the 45 women 5.2+/-3.9 months after TV-EST.

CONCLUSION

Although only a small number of women were studied, our observational study suggested that TV-EST appeared not to adversely affect reproductive performance in subfertile women with ovarian endometriotic cysts.

Fluid collections detected by ultrasound following uncomplicated colorectal surgery

The aim of the study was to assess the incidence and site of intraperitoneal fluid collections following uncomplicated colorectal surgery and to identify factors relating to the presence of such collections. 38 patients (22 males) with a mean age of 67 years (range 38-85 years) undergoing uncomplicated colorectal procedures were studied prospectively. Patients underwent abdominal and pelvic ultrasound on Day 3 and Day 7 following surgery. The number, site and volume of collections were recorded. Ultrasound-detected fluid collections were present in 26% on Day 3 and 25% on Day 7 following laparotomy. The presence of a collection was not related to the amount of residual volume after peritoneal lavage with normal saline prior to operative closure, to intraoperative blood loss or to the presence of drains. The right upper quadrant was the commonest site of intraperitoneal collections. In the absence of additional clinical signs, the presence of such collections is not an indication for intervention.

Comparison of fine-needle aspiration cytologic findings of ovarian cysts with ovarian histologic findings

OBJECTIVE

The purpose of this study was to compare cytologic findings of fluid from ovarian cysts with ovarian histologic findings.

STUDY DESIGN

Ovaries submitted for pathologic examination were grossly examined for ovarian cysts. Fluid was removed by needle aspiration from intact ovarian cysts and prepared for cytologic examination. The cytologic findings were categorized as benign, malignant, indeterminate, and nondiagnostic. Histologic classification was assigned using the guidelines established by the World Health Organization. A single pathologist evaluated each cytologic specimen and was blinded to the gross appearance and histologic findings of each ovary. Cytologic diagnoses were compared with the histologic diagnoses.

RESULTS

The study material consisted of 105 ovaries from 98 women. A comparison of the ovarian histologic findings with the cytologic diagnosis was performed in 89 of 105 cases. Histologic examination of the ovaries revealed 89 benign ovarian tumors and 13 ovarian carcinomas. The sensitivity of ovarian cyst cytologic evaluation was 25%, and the specificity was 90%. The false-positive rate for ovarian cytologic evaluation was 73%, and the false-negative rate was 12%.

CONCLUSIONS

Cytologic examination of aspirated ovarian cyst fluid does not accurately predict ovarian histologic findings.

Role of puncture and aspiration in expectant management of simple ovarian cysts: a randomised study

OBJECTIVES

To assess the potential of expectant management for simple ovarian cysts diagnosed by transabdominal or transvaginal ultrasonography. To compare the results of needle aspiration with those achieved with simple observation.

DESIGN

Randomised trial.

SETTING

Hospital department of obstetrics and gynaecology.

SUBJECTS

278 women with simple cysts randomly allocated to simple observation (143) or ultrasound guided fine needle aspiration (135) between 1990 and 1994.

MAIN OUTCOME MEASURES

Resolution of cyst or development of malignancy.

RESULTS

After six months 269 were available for follow up. The rate of resolution was 46% (59/128) with aspiration and 44.6% (63/141) with observation. Only the diameter of the cyst (P < 0.0001) was a significant independent prognostic factor for resolution in a multivariate analysis. Age and treatment had no significant effect. One woman was subsequently found to have borderline malignant changes on histopathological examination. Her cyst was detected by transabdominal ultrasonography.

CONCLUSIONS

Expectant management for up to six months does not cause risks for the patients and allows spontaneous resolution in over a third of cases, avoiding the costs and risks of unnecessary surgery. Aspiration does not provide better results than simple observation.

Ovarian cysts

The Author intends to compare the data available in literature on the topic of 'laparoscopic surgery of ovarian cysts' to his case material. From 1985 to 1994, the author carried out 920 laparoscopic operations for the removal of ovarian cysts. Of these, 13 were converted to laparotomies, mostly because of peri-adnexal adhesions. There were 22 recurrences (endometriosic and mucinous multilocular cysts), and five severe complications (two purulent inflammations, one intra-operative haemorrhage and one post-operative one, one post-operative acute abdomen sine causa). In one case, an unrecognised endometrioid carcinoma was inadequately treated with laparoscopy. The author considers laparoscopy as the elective choice for surgical treatment of ovarian cysts. Suspect malignancy is not a contra-indication to laparoscopic surgery, since the removal of the operative specimen and its subsequent histological examination can be effected-in the large majority of cases-with the same results both laparoscopically and laparotomically. There is a problem with undiagnosed carcinomas in fertile females, but it is equally present in laparotomy.

Ultrasound-guided aspiration of endometriomas: possible applications and limitations

OBJECTIVES

To evaluate the role of needle aspiration in the management of endometriomas.

DESIGN

Retrospective evaluation of the activity of the section of interventional ultrasound in a single tertiary care institution.

SETTING

Department of Obstetrics and Gynecology, Ospedale S. Gerardo, Monza, University of Milan, Italy.

PATIENTS

Two hundred nine premenopausal patients underwent aspiration for diagnostic purpose (n = 166), for relief of symptoms (n = 25), or with therapeutic intent (n = 18).

RESULTS

Adequate material was obtained by all punctures. Early complications (self-limiting vagal symptoms or pain) occurred in eight cases. Short-term complications consisted of acute abdominal pain in three cases and infection in one. Three women required surgical treatment of the complication. At first examination after aspiration, persistence of the cyst was observed in all but four cases, including all cases who had undergone therapeutic aspiration. Nine patients reported relief of symptoms but six other patients referred onset or worsening of pelvic discomfort after aspiration.

CONCLUSIONS

Ultrasound-guided aspiration of endometriomas is feasible. The transvaginal route reduces early complication but implies a risk of infection of 1.3%. However, drainage alone is ineffective as a therapeutic procedure and the applications of aspiration of endometriomas appear limited to some cases with diagnostic intent.

Cytologic diagnosis of ovarian tumors: factors influencing accuracy in previously undiagnosed cases

OBJECTIVES

Cytologic diagnosis of ovarian masses by needle aspiration techniques remains controversial. This review proposes to define the accuracy of the technique, report complications, and relate clinical situations in which the technique was used.

STUDY DESIGN

In a retrospective review all patients undergoing cytologic aspiration biopsy diagnosis of ovarian masses at the University of Virginia Health Sciences Center from 1986 through 1993 were identified, and 74 women with corresponding histologic material were used. Clinical data were abstracted and all cytologic and pathologic material was reviewed.

RESULTS

The overall sensitivity of the 74 aspiration biopsies to predict the histologic diagnosis of malignancy was 78%; specificity was 92%. Two patients had complications, one necessitating operative intervention. Correct diagnoses were influenced by menopausal status, patient age, sample type, aspiration method, and cytologic quality.

CONCLUSIONS

The cytologic diagnoses of ovarian tumors, while quite specific, lack the sensitivity for general application. Use of this diagnostic technique must remain individualized, and the factors that influence the accuracy of the technique must be kept in mind. There remains the need for standardization of reporting fine needle aspiration results.

Preoperative sonographic evaluation and laparoscopic management of persistent adnexal masses: a 1994 review

Carcinoma of the ovary is a frightening disease because it is a major cause of death due to cancer in women and is the leading cause of deaths from gynecologic malignancies. The disease is associated with a common clinical problem: persistent adnexal masses, most of which are benign. Operative laparoscopy has become an increasingly attractive way of diagnosing and removing adnexal masses. The practicing general gynecologist thus faces two new dilemmas: not to miss an early ovarian cancer or manage an unsuspected one to the patient's detriment, and not to perform extensive major surgery for adnexal masses, most of which can be handled laparoscopically. Fortunately, pertinent data exist on which the resolution of these dilemmas may be based.