A comparative study of three scoring systems on palpable breast aspirates at a tertiary health-care center: A cross-sectional study

Abstract

Background: The cytological grading system in fine-needle aspiration of breast lumps helps the surgeons to decide the method of management and assess the survival rate. However, till date, no single cytological grading system for breast aspirates has been adapted in routine practice. Hence, a comparative study of three different grading systems was done. Materials and Methods: This is a retrospective study conducted from January 2016 to June 2018. The stained aspirated smears of breast lump were assessed for cytomorphologic features and graded as per the Modified Masood's Scoring Index (MMSI), National Cancer Institute (NCI) Cytological Grading System, and Robinson's cytological grading and compared with histological diagnosis (four categories) and modified Scarff–Bloom–Richardson's scoring system (carcinoma cases). Results: The MMSI system had a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of 80%, 100%, 100%, 92.86%, and 94.44%, respectively. The NCI system had a sensitivity, specificity, PPV, NPV, and diagnostic accuracy of 60%, 97.44%, 90.0%, 86.36%, and 87.04%, respectively. The Robinson's cytological grading system had a sensitivity, specificity, PPV, NPV, and diagnostic accuracy of 100%, 84.62%, 71.43%, 100%, and 88.89%, respectively. Conclusion: Robinson's scoring system is the system with maximum sensitivity and is most effective in subcategorizing only malignant breast lesions. MMSI is the system with maximum specificity, PPV, and diagnostic accuracy, and can be considered as the standard grading system for both benign and malignant breast lesions on cytology.