Fine-needle aspiration cytology of ovarian cysts in in vitro fertilization patients: a study of 125 cases

Fine-needle aspiration (FNA) cytology of ovarian cysts, especially in in vitro fertilization (IVF) patients, has been only rarely reported. The aim of this study was to describe the spectrum of cytological findings seen in FNA specimens of 125 ovarian cysts obtained from 84 IVF patients at our institution from 1989-1993. The Papanicolaou-stained slides made following cytocentrifuge or membrane-filter preparation were reviewed blindly by two independent pathologists, and the consensus diagnoses were compiled and correlated with clinical and radiological findings as well as surgical pathology when available. Eight aspirates derived from 4 different patients contained neoplastic cells and, of these, one patient was later found to have a serous cystadenocarcinoma of low malignant potential, while another had a serous cystadenoma. The other 2 patients with neoplastic cells in their ovarian aspirates have persistent ovarian cysts that are being followed clinically for preservation of fertility. The breakdown of the cytological diagnoses of the other aspirates is as follows: 30 follicular cysts, 5 corpus luteum cysts, and 16 endometriotic cysts. The exact underlying nature of 66 cysts could not be determined as the aspirates consisted of foamy macrophages only. This study demonstrates that the nature of ovarian cysts in IVF patients can be determined in many cases by their cytological features, information that may help in defining an unsuspected cause for infertility (such as endometriosis), and in choosing the most appropriate therapy. This study also illustrates that FNA cytology of ovarian cysts can play a role in the detection of occult ovarian neoplasms in the IVF patients population.