The case against aspirating ovarian cysts

Developments in ultrasonographic technology have increased the possibilities of ovarian cyst aspiration. The risk of an extension of indications for ovarian cyst aspiration, however, is iatrogenic spread of malignant cells.

In this article, the diagnostic accuracy and therapeutic effectiveness of ovarian cyst aspiration are discussed, and the potential risk from different forms of tumor spill are considered.

Two cases are presented in which a laparoscopic puncture and aspiration of a malignant ovarian cyst were performed. In both cases, there were diagnostic problems with the cytologic assessment. In one case, aspiration of an apparently benign cyst, based on ultrasonographic and laparoscopic findings, yielded cytologically negative fluid, but 8 weeks later an extensively disseminated ovarian carcinoma was found at laparotomy. It is postulated that the time interval between first tumor spill and eventual removal of the diseased ovary is the most important determinant of prognosis.

The conclusion of these case reports is that aspiration of ovarian cysts, except for the purposes of oocyte retrieval, is potentially dangerous and should not be regarded as routinely acceptable clinical practice.