Utility of Scrape Cytology in Management of Ovarian Neoplasms: a Cross-sectional Study in a Tertiary Care Hospital of Eastern India

Abstract

Ovarian tumors are one of the most common gynecological neoplasms worldwide affecting women of all ages. As preoperative diagnosis is often inaccurate, intraoperative diagnostic modalities play indispensable role in management of ovarian tumors to avoid unnecessary extensive surgery. Although reliable, frozen section is highly expensive for resource-poor developing countries. Intraoperative cytological methods can help to overcome these limitations. The aim of this study was to evaluate the accuracy of scrape cytology in diagnosis of ovarian tumors. The freshly removed specimens of ovarian tumors sent without any fixative during the study period were included in this observational prospective cross-sectional study. Scraping was done from the most representative area of the cut surface of the tumor. Cytological smears were stained by hematoxylin-eosin method. All the cytological smears and corresponding histological sections were evaluated separately. Cytological interpretation was then compared with histological diagnosis to assess the diagnostic accuracy of scrape cytology. On histology, 66 cases were diagnosed as benign (60%), 5 cases as borderline (4.55%), and 39 as malignant (35.45%). Of these, 64 cases (58%) were of epithelial origin, 25 cases (22.7%) were of germ cell origin and 6 (5.45%) cases were categorized as sex cord-stromal tumor. Accuracy of scrape cytology in diagnosis of benign, borderline, and malignant ovarian tumors was found to be 95.45%, 40%, and 89.74%, respectively. Overall accuracy rate was 90.91%. Scrape cytology is a rapid, inexpensive yet effective tool to diagnose benign and malignant ovarian tumors with high diagnostic accuracy.

Keywords: Diagnostic accuracy; Ovarian neoplasms; Scrape cytology.

Fig. 1

Mucinous cystadenoma showing columnar mucinous epithelium arranged in single row (A scrape cytology, B histology). Endometrioid carcinoma showing pleomorphic tumour cells and squamous metaplasia (C scrape cytology, D histology) (H&E, × 400)

Fig. 2

Dysgerminoma showing large cells and lymphocytes (A scrape cytology, B histology) (H&E, × 400). Mature cystic teratoma: C scrape cytology showing aneucleated squames (H&E, × 400); D histology showing mature squamous epithelium (H&E, × 100)

Fig. 3

Granulosa cell tumor showing longitudinal nuclear groove (A scrape cytology, B histology). Fibrothecoma showing bland spindle cells (C scrape cytology, D histology) (H&E, × 400)