The role of fine-needle aspiration cytology of the testis in the diagnostic evaluation of infertility.

To compare the diagnostic value of cytological smears of fine-needle aspirate with that of histological sections obtained by testicular biopsy in the evaluation of infertility. The study included 60 patients with azoospermia or severe oligospermia (sperm counts of < 5 million/mL). A detailed history was taken and the external genitalia examined. Testicular samples were obtained by fine-needle aspiration using a 10 mL syringe and 21 G needle; the air-dried smears were stained using the May-Grunwald-Giemsa method. A testicular biopsy was taken after exploring the same tract and these sections were stained with haematoxylin and eosin. The cytological smears and histological sections were examined separately and the results compared. The cytological smears were divided into three groups: normal, with all spermatogenic cells present; Sertoli-cell only syndrome; and spermatogenic arrest (all spermatogenic cells present except spermatids and spermatozoa). There was a good correlation between the diagnosis on the cytological smears and histological sections in 58 of 60 patients (97%). In two patients there was scanty aspirate and few cells, giving an inaccurate diagnosis. Interstitial cells were not detected on cytological smears. In three patients, Sertoli-cell only was diagnosed on cytology, and histology revealed additional features of Leydig cell hyperplasia. Fine-needle aspiration of the testis is a simple and minimally invasive technique for diagnostic evaluation, especially in patients with obstructive azoospermia. Patients with abnormal findings on fine-needle aspiration cytology may be evaluated histologically by further biopsy.