Is differentiation of benign and malignant cystic adnexal masses possible by evaluation of cysts fluids with respect to color, cytology, steroid hormones, and tumor markers?

OBJECTIVE: Differentiation of benign and malignant cystic adnexal masses by analysis of cyst fluid was investigated. STUDY DESIGN: Eighty-one cystic adnexal lesions of 80 patients were punctured intraoperatively or after surgical removal. Color of the cyst fluid, cytology, concentrations of steroid hormones (estradiol, progesterone, testosterone), and tumor markers (CEA, CA 125, CA 15-3) were correlated to histology. RESULTS: Color of cyst fluid was not reliable in the differential diagnosis of cystic adnexal masses. Cytology missed four out of seven malignant tumors. One mucinous cystadenoma was cytologically suspicious for malignancy. The combination of negative cytology, low tumor marker levels, and estradiol levels higher than 1000 pg/ml may support the diagnosis of a 'functional' cyst. Elevated CEA levels may be suspicious for all mucinous and malignant lesions. CONCLUSION: Analysis of cyst fluid could not accurately discriminate between benign or malignant tumors.