12
Peritoneal Washings and Ovary
nondiagnostic material such as proteinaceous material and
blood—reported in 47% of aspirates from malignant cysts in
one series.83
When diagnostic material is obtained, the diagnostic accu-
racy reported by experienced observers is generally quite high.
An early study of FNA of palpable masses, many of which were
solid tumors, revealed a sensitivity of 93% and specificity of
95%.35 False-positive diagnoses are rare but may occur with cel-
lular follicle cysts or serous cystadenomas with atypia.51,52,55,61
Other studies have shown the sensitivity of ovarian cyst fluid
cytology to be as low as 25%, with a false-negative rate of 12%
and false-positive rate as high as 73%.40
Concluding Remarks
Peritoneal Washings
Peritoneal cytology has an important role in the diagnosis and
staging of abdominal and pelvic malignancies. Diagnostic pit-
falls can be avoided by having an understanding of the different
methods of sampling, a familiarity with cytomorphology of the
various specimen types, adequate clinical history, and an ability
to prepare cell blocks and/or review other prior or concurrent
specimens. Ancillary techniques such as immunohistochem-
istry may be useful in selected cases. More recently molecular
methods have been shown to have potential for allowing iden-
tification of small numbers of cancer cells from body fluids not
apparent on morphology alone.
Ovary
FNA has become a useful diagnostic and therapeutic tool in
the evaluation of clinically and sonographically nonsuspicious
cystic ovarian masses due to increasing experience in the cyto-
logic interpretation of cystic fluids and improvements in the
technology of high-frequency sonography. Key diagnostic fea-
tures of non neoplastic and neoplastic ovarian cysts have been
described. When representative samples are obtained the diag-
nostic accuracy is high. Careful evaluation of clinical and ultra-
sonographic information should be applied to all cysts prior to
aspiration to limit the risk of aspirating a malignant neoplasm
and possible peritoneal seeding.
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