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Ealing Hospital:
Saturday 20th November 1999
Dr Sanjiv Manek, Consultant Pathologist, John Radcliffe Hospital,
Oxford, gave this talk for the fourth time this year, following
a five year focus to overcome limitations for ovarian testing and
to develop techniques to enhance its usefulness.He
found no foundation to the history of concern relating to peritoneal
seeding following ovarian cyst aspiration. Aspiration /non-aspiration
of high-grade tumours yielded no difference in 5/10 year survival
rates.
Aspiration technique is still an 'esoteric' science, and the limitations
addressed were:
- Sampling,
which can be improved by better imaging e.g. MRI scanning.
- ‘Real'
targets are easily missed, such as borderline areas / focal malignancy
in benign cysts.
- Some false
negatives are caused by lack of relevant cellularity - possibly
caused by both the thinness of the cyst lining and/ or inadequate
processing. Cytocentrifuged 2MG/G and 2 Paps and many spares are
needed as several preps from one case need to be studied.
- Lack of expertise
in interpretation - false positive results are caused by misinterpretation
of cellular functional cysts, atypia in endometriotic cysts, and
ovarian surface metaplasia.
Immunocytochemistry
assists differentiation between functional and epithelial cysts.
The latter requires removal as borderline / cancerous changes occur
in epithelial cysts. Immunocytochemistry also has a role in aiding
recognition of differential diagnoses, and is most useful in haemorrhagic
cysts. Screening using immunocytochemistry can be used to monitor
cysts, and provide an alternative to a second look operation.
When inoperable, aspiration debulks cysts.
Dr Manek concluded
that markedly hypocellular samples should be reported as non-diagnostic.
He sees ovarian aspiration cytology as a useful diagnostic and monitoring
tool in skilled hands, and asserts that workshops are needed to
bring confidence to the area for investigation.
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