Evaluation of estradiol in aspirated ovarian cystic lesions

During a three-year period, 217 ovarian cystic lesions were evaluated by both fine needle aspiration (FNA) cytology and estradiol (E2) assay at Royal Women's Hospital. One hundred three ovarian lesions were subsequently subjected to histologic examination, and 79 cyst fluids were assayed for progesterone. Of the 151 cystic lesions diagnosed by cytology/histology, 50 were follicular cysts, and 90% had E2 content > 20 nmol/L. The remaining 101 nonfollicular cystic lesions represented a heterogeneous group, but 99% had E2 content < 20 nmol/L. The sensitivity of E2 content > 20 nmol/L for follicular cysts was 90% and the specificity 99%. In contrast, progesterone was elevated in follicular cyst fluid but also in many other types of cysts. Consideration of E2 content in the 66 cysts undiagnosed by histology/cytology revealed 33 follicular cysts. The precise nature of the 33 nonfollicular cystic lesions remains unknown, and further investigations, including surgery, are warranted. It is concluded that E2 assay, unlike progesterone assay, constitutes a useful ancillary diagnostic clue in the evaluation of ovarian cystic lesions in the premenopausal woman.