Ovarian cytology a poor screening test for malignancy in children

1. The overall incidence of ovarian mass malignancy was low.

2. Fine needle aspiration cytology (FNAC) had low sensitivity and high specificity for detecting malignancy in children and adolescents with ovarian masses.

Evidence Rating Level: 2 (Good)

Study Rundown: Ovarian masses in the pediatric population may represent cysts, benign growths or malignant neoplasms. Patients can present with pain or may be asymptomatic with an incidental diagnosis of an adnexal mass noted on physical exam or imaging. While the overall incidence of ovarian malignancy is low in this group, further evaluation is often necessary to exclude malignancy considering the high mortality rate associated with ovarian cancer. Prior studies in adult women demonstrate that cytology has poor sensitivity for identifying malignancy and can result in port site metastasis, a complication of FNAC in which cancer cells are seeded into the peritoneum at the time of biopsy. For these reasons, current guidelines discourage the use of FNAC in evaluation of ovarian masses. To date, the role of FNAC among children and adolescents with ovarian masses has not been well established. In the present work, authors evaluated the diagnostic accuracy of FNAC in girls younger than 18 years who underwent cytological and histological assessment of an ovarian mass. They found that FNAC had excellent specificity but poor sensitivity for detecting ovarian malignancy, suggesting that FNAC is a poor screening test.

Strengths of the study were data from a large national registry and prospective analysis of cytology and histology. Weaknesses of this study included retrospective design, limited generalizability to other populations, and possible variation in technique across the study period and/or labs. Further evaluation of FNAC in conjunction with other diagnostic tools such as imaging and tumor markers is needed to determine whether there is a role for its use in the evaluation of pediatric ovarian masses.

Click to read the study in Human Reproduction

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

In-Depth [retrospective cohort]: This study evaluated concordance between cytology and histology in 552 female children and adolescents less than 18 years who had ovarian pathology reports available in a national registry. The primary outcomes of interest were sensitivity and specificity of FNAC.

FNAC had a sensitivity of 32.0% (95% CI: 15.0-53.5) and specificity of 99.8% (95% CI: 98.7-100). The post-test probability after negative cytology was 3.8%, compared to the 5.5% incidence of malignancy in the study population.

Image: PD

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