Intraoperative Cytological Diagnosis of Ovarian Cancer

  • Helmy A. RadyEmail author
  • Noha E. Mohammed
  • Mohammed Farag
Original Article



Ovarian cancer is one of the three most common malignant tumors in the female reproductive system. It has an insidious onset with a difficult early diagnosis. In approximately 70% of all cases of ovarian cancer, the disease is not diagnosed before reaching an advanced stage. The 5-year survival rate is associated with ovarian cancer staging. Intraoperative cytology is a method of intraoperative consultation with the help of cytology smears. Histopathology is the gold standard in the diagnosis of resected specimens. Imprint cytology offers the advantage of viewing the gross, giving serial cuts, taking multiple representative samples and most importantly, being inexpensive and logistically un-demanding.


This study was conducted on 100 patients with ovarian tumors diagnosed by clinical, ultrasound and histopathological examination in Gyne-oncology unit in El Shatby Maternity University Hospital. All 100 cases had ovarian mass diagnosis confirmed through the collection and interpretation of intraoperative findings and histopathological report.


The sensitivity of imprint cytology in the present study was 88.10% and specificity of 82.82% with a positive predictive value of 82.22% and a negative predictive value of 87.80%.


Imprint cytology is an excellent method of giving a quick and reliable diagnosis; cytology plays an important role by guiding the surgeon within a short period of time. It is a preferred method for investigation due to sensitivity, specificity, positive predictive value and outcome of the patient and because it is simple and inexpensive. The cytology preparations were helpful in supporting the histological diagnoses. However, imprint cytology may not be very reliable in cases of borderline epithelial tumors.


Imprint cytology Intraoperative cytology Ovarian cancer Malignant tumors 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Human and Animal Rights Statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010;127(12):2893–917.CrossRefGoogle Scholar
  2. 2.
    Michaud DS, Giovannucci E, Willett WC, Colditz GA, Fuchs CS. Coffee and alcohol consumption and the risk of pancreatic cancer in two prospective United States cohorts. Cancer Epidemiol Biomark Prev. 2001;10(5):429–37.Google Scholar
  3. 3.
    Selvaggi SM. Tumors of the ovary, maldeveloped gonads, fallopian tube, and broad ligament. Arch Pathol Lab Med. 2000;124(3):477.PubMedGoogle Scholar
  4. 4.
    Rieber A, Nüssle K, Stöhr I, Grab D, Fenchel S, Kreienberg R, et al. Preoperative diagnosis of ovarian tumors with MR imaging: comparison with transvaginal sonography, positron emission tomography, and histologic findings. AJR Am J Roentgenol. 2001;177(1):123–9.CrossRefGoogle Scholar
  5. 5.
    Garcia-Soto AE, Boren T, Wingo SN, Heffernen T, Miller DS. Is comprehensive surgical staging needed for thorough evaluation of early-stage ovarian carcinoma? Am J Obstet Gynecol. 2012;206(3):242-e1–5.CrossRefGoogle Scholar
  6. 6.
    Swart A. Long-term follow-up of women enrolled in a randomized trial of adjuvant chemotherapy for early stage ovarian cancer (ICON1). J Clin Oncol. 2007;25(90180):5509.Google Scholar
  7. 7.
    Bal MS, Kahlon SK, Bidani R. Comparative evaluation of aspiration cytology and preoperative imprint cytology in breast lesions. J Cytol. 2000;17:27–32.Google Scholar
  8. 8.
    Ranjan A, Chandke RK, Chauhan N, Kumari R. Study of tumors by imprint cytology. Indian J Clin Pract. 2013;24(5):472–7.Google Scholar
  9. 9.
    Kar T, Kar A, Mohapatra PC. Intra-operative cytology of ovarian tumors. J Obstet Gynecol India. 2005;55(4):345–9.Google Scholar
  10. 10.
    Chen EY, Lee KR, Nucci MR. Intraoperative evaluation of ovarian tumors. In: Crum CP, Nucci MR, Lee KR, editors. Diagnostic gynecologic and obstetric pathology. 2nd ed. Philadelphia: Elsevier Saunders; 2011. p. 800–17.CrossRefGoogle Scholar
  11. 11.
    Santǐn CA, Sica A, Melesi S, Feijó A, Garrido G, Rodríguez Alvarez C. Contribution of intraoperative cytology to the diagnosis of ovarian lesions. Acta Cytol. 2011;55(1):85–91.CrossRefGoogle Scholar
  12. 12.
    Manuals for Training in Cancer Control; Manual of cytology; Directorate General of Health Services; Ministry of Health and Family Welfare. Government of India. November 2005.Google Scholar
  13. 13.
    Kirkpatrick LA, Feeney BC. A simple guide to IBM SPSS statistics for version 20.0. Belmont, Calif.: Wadsworth, Cengage Learning; 2013.Google Scholar
  14. 14.
    Samantaray S, Nayak B, Das U, Mishra S, Giri SK, Rout N. Utility of intra-operative cytological diagnosis in cases of ovarian tumours. Natl Lab Med. 2017;6(1):PO12-7.Google Scholar
  15. 15.
    Das C. A Cytohistological correlation in ovarian tumours. IOSR J Dent Med Sci. 2014;13(1):1–5.CrossRefGoogle Scholar
  16. 16.
    Shahid M, Zaheer S, Mubeen A, Rahman K, Sherwani R. The role of intraoperative cytology in the diagnostic evaluation of ovarian neoplasms. Acta Cytol. 2012;56(5):467–73.CrossRefGoogle Scholar
  17. 17.
    Nagamine K, Kondo J, Kaneshiro R, Tauchi-Nishi P, Terada K. Ovarian needle aspiration in the diagnosis and management of ovarian masses. J Gynecol Oncol. 2017;28(4):e40.CrossRefGoogle Scholar
  18. 18.
    Nagai Y, Tnanaka N, Horiuci F, Ohki S, Sekiya S. Diagnostic accuracy of intraoperative cytology in ovarian epithelial tumour. Int J Gynaecol Obstet. 2001;72:159–64.CrossRefGoogle Scholar
  19. 19.
    Khunamornpong S, Siriaunkgul S. Scrape cytology of the ovaries: potential role in intraoperative consultation of ovarian lesions. Diag Cytopathol. 2003;28:250–7.CrossRefGoogle Scholar
  20. 20.
    Annaiah TK, Reynolds SF, Lopez C. Histology and prevalence of ovarian tumours in postmenopausal women: is follow-up required in all cases? J Obstet Gynaecol. 2012;32(3):267–70.CrossRefGoogle Scholar
  21. 21.
    Gupta N, Rajwanshi A, Dhaliwal LK, Khandelwal N, Dey P, Srinivasan R, Nijhawan R. Fine needle aspiration cytology in ovarian lesions: an institutional experience of 584 cases. Cytopathology. 2012;23(5):300–7.CrossRefGoogle Scholar
  22. 22.
    Roy M, Bhattacharya A, Roy A, Sanyal S, Sangal M, Dasgupta S. Fine needle aspiration cytology of ovarian neoplasms. J Cytol. 2003;20:31–5.Google Scholar
  23. 23.
    Fox H, Wells M. Heins and Taylor obstetrics and gynaecological pathology. 5th ed. London: Charchill Livingstone; 2003. p. 585–912.Google Scholar
  24. 24.
    Ganesan R, Hirschowitz L, Baltrušaitytė I, McCluggage WG. Luteinized adult granulosa cell tumor—a series of 9 cases: revisiting a rare variant of adult granulosa cell tumor. Int J Gynecol Pathol. 2011;30(5):452–9.CrossRefGoogle Scholar
  25. 25.
    Rao S, Sadiya N, Joseph LD, Rajendiran S. Role of scrape cytology in ovarian neoplasms. J Cytol. 2009;26(1):26–9.CrossRefGoogle Scholar
  26. 26.
    Harbhajanka A, Lamzabi I, Jain R, Syed S, Murro D, Gattuso P. Fine needle aspiration cytology of cystic primary adult granulosa cell tumor of the ovary: potential diagnostic pitfalls with other cystic ovarian lesions. Diagn Cytopathol. 2016;44(6):461–5.CrossRefGoogle Scholar
  27. 27.
    Vijayakumar A. The diagnostic utility of intraoperative cytology in the management of ovarian tumors. J Clin Diagn Res. 2013;7(6):1047–50.PubMedPubMedCentralGoogle Scholar
  28. 28.
    Bandyopadhyay A, Chakraborty J, Chowdhury AR, Bhattacharya A, Bhattachrya P, Chowdhury M. Fine needle aspiration cytology of ovarian tumors with histological correlation. J Cytol Indian Acad Cytol. 2012;29(1):35–40.CrossRefGoogle Scholar
  29. 29.
    Dey S, Misra V, Singh P, Mishra S, Sharma N. Role of intraoperative imprint cytology in diagnosis of suspected ovarian neoplasms. Asian Pac J Cancer Prev. 2010;11(5):1389–91.PubMedGoogle Scholar
  30. 30.
    Bohara S, Jain S, Khurana N, Shangpliang DM, Agarwal S, Gandhi G. Intraoperative cytology of ovarian neoplasms with an attempt to grade epithelial tumors. J Cytol. 2018;35(1):1–7.CrossRefGoogle Scholar
  31. 31.
    Shalinee R, Sadiya N, Leena DJ. Role of scrape cytology in ovarian neoplasms. J Cytol. 2009;26:26–9.CrossRefGoogle Scholar
  32. 32.
    Mikami M. Tumour imprint cytology sclerosing stromal tumour of ovary. Diagn Cytopath. 2003;28:54–7.CrossRefGoogle Scholar
  33. 33.
    Matsuno RK, Sherman ME, Visvanathan K, Goodman MT, Hernandez BY, Lynch CF, et al. Agreement for tumor grade of ovarian carcinoma: analysis of archival tissues from the surveillance, epidemiology and end results residual tissue repository. Cancer Causes Control. 2013;24(4):749–57.CrossRefGoogle Scholar
  34. 34.
    Chandrakar J, Srivastava S. Evaluation of the relevance of touch imprint cytology in the diagnosis of various neoplastic lesions. Int J Res Med Sci. 2015;3(11):3046–50.CrossRefGoogle Scholar

Copyright information

© Association of Gynecologic Oncologists of India 2019

Authors and Affiliations

  • Helmy A. Rady
    • 1
    Email author
  • Noha E. Mohammed
    • 1
  • Mohammed Farag
    • 1
  1. 1.Department of Obstetrics and Gynaecology, Faculty of Medicine, El Shatby Maternity University HospitalUniversity of AlexandriaAlexandriaEgypt

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