Accuracy of Testicular Fine Needle Aspiration Cytology to rule out Obstructive and non-obstructive Azoospermia

Abstract

Objective: To establish if testicular aspiration can separate men with obstructive from those with non-obstructive azoospermia.

Methodology: This cross-sectional study was carried out from June 2023 to May 2024 at Mayo Hospital, Lahore. All patients included in the study (n=50) were found to be azoospermic. Sensitivity, specificity, PPV, NPV and the overall diagnostic accuracy were examined by looking at FNAC findings and comparing them with the testicular biopsy results.

Results: Testicular FNAC demonstrated high diagnostic accuracy in differentiating OA from NOA, correctly classifying 92% of cases (46/50) compared to biopsy. It showed 95.6% sensitivity and 88.9% specificity, with strong agreement with histopathology (?=0.83). ROC analysis revealed excellent discriminative ability (AUC=0.923, 95% CI: 0.852-0.994). While FNAC reliably identified spermatogenic patterns, 8% of cases (4/50) were misclassified, emphasizing the need for clinical correlation in borderline scenarios.

Conclusion: FNAC of the testicle offered great reliability in differentiating obstructive azoospermia from non- obstructive azoospermia and was less invasive compared to testicular biopsy. A limited number of cases being misclassified suggests that health professionals should exercise careful interpretation.