A Comparative Study Between Fine-Needle Aspiration Cytology and Core Needle Biopsy in Diagnosing Clinically Palpable Breast Lumps.

Abstract

Background and objectiveMost breast diseases present as palpable lumps. The accuracy of their diagnosis can be enhanced by a combination of clinical examination, mammography, fine-needle aspiration cytology (FNAC), and core needle biopsy (CNB) preoperatively. The ultimate aim of FNAC or CNB of the breast mass is to confirm the diagnosis of cancer preoperatively, which may help avoid unnecessary surgeries for benign conditions. Histopathology is the gold standard to establish the diagnosis of a breast mass. In this study, we aimed to compare the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of FNAC with those of trucut biopsy, and provide a combined assessment of FNAC and CNB against the final histopathological diagnosis of excised breast mass in suspected breast malignancies.Materials and methodsThis was a prospective, observational, cross-sectional study conducted for a duration of one year involving 42 patients with suspected breast cancer cases who underwent FNAC, CNB, and surgical excision followed by a histopathological examination. Data were collected and analyzed in terms of sensitivity, specificity, PPV, NPV, and diagnostic accuracy of FNAC and CNB in comparison with histopathology.ResultsThe majority of the patients in the study (78.6%) were in the age group of 31-50 years. In our study, FNAC showed a sensitivity, specificity, PPV, NPV, and diagnostic accuracy of 74.1%, 76.9%, 87.0%, 64.7%, and 75% respectively. CNB had a sensitivity, specificity, PPV, NPV, and diagnostic accuracy of 85.2%, 92.8%, 95.8%, 76.5%, and 87.8% respectively. The level of agreement between the two modalities (FNAC and CNB) was moderate and statistically significant (k=0.543; p<0.001). In the combined assessment of FNAC and CNB against final histopathological diagnosis for malignancy/borderline diagnosis, the sensitivity, specificity, PPV, NPV, and diagnostic accuracy were 89.3%, 85.7%, 92.6%, 80%, and 88.1% respectively.ConclusionThe diagnostic accuracy of the combined assessment of FNAC and CNB against final histopathological diagnosis for malignancy/borderline diagnosis was better than that of FNAC or CNB alone. This finding shows that both the techniques complement each other. FNAC and CNB are used as the first- and second-line methods of pathological diagnosis respectively.