Objective: To determine the diagnostic accuracy of cytologic evaluation of ovarian cystic masses. Study Design: Sixty-seven ovarian cystic masses with fine needle aspiration cytology and concurrent or subsequent cystectomy/oophorectomy with histology were examined. Correlations with malignancy were made with 4 parameters: serum CA-125, radiographic size and architecture, and cytology. Results: Histologic examination of the 67 cases revealed 10 malignancies including 3 primary ovarian carcinomas, 2 metastatic neoplasms, and 5 borderline tumors. In the 10 malignant cases, the cytologic diagnoses were that of benign (n = 2), benign but non-diagnostic/paucicellular (n = 3), and atypical/malignant (n = 5), giving an overall sensitivity for cytology of 50%. However, there were no false positives (specificity of 100%). Reasons for the low sensitivity of cytology were the paucicellular nature of aspirate (n = 3), focality of ovarian borderline tumors (n = 5), and surface involvement by metastatic cancer (n = 2). The 4 parameters were independent of one another and none proved to have significant correlation with malignancy (p > 0.05). Thirty-nine percent of the aspirates had low cellularity (6% non-diagnostic/33% pauci-cellular). Conclusions: Cytology was the only parameter with 100% specificity and 100% positive predictive value. However, paucicellular specimens are a common problem in aspiration from this site.