Comparison of Ultrasonography and Fine Needle Aspiration Cytology in the Diagnosis of Malignant Breast Lesions in a Rural Setup

Abstract

Abstract Introduction: Breast cancer is the most common cancer diagnosed in women worldwide. These rising trends have emphasized the need of prompt detection, effective clinical evaluation, and exact diagnosis of the breast disease. Aim: To analyze and compare the sensitivity, specificity, and predictive values and accuracy of ultrasonography (USG) and fine needle aspiration cytology (FNAC) in diagnosing malignant breast lump. Materials and methods: A cross-sectional, prospective study was done. One hundred sixteen female patients attending surgery department with breast lump were included. After complete clinical evaluation of the lump, all patients underwent USG and FNAC examination for diagnosis of the lump, and further subjected to excisional biopsy/definitive surgery, the results of which were further compared with the histopathological results to determine the accuracy, sensitivity, specificity, and predictive values of FNAC and USG. Results: Out of 116, 61 (52.58%) benign lesions were found while the remaining 55 (47.41%) resulted to be malignant lesions on histopathological examination (HPE). Ultrasonography reported 46 true positive, 60 true negative, and 4 false negative cases with 6 inconclusive reports; whereas, FNAC reported 47 true positive, 61 true negative, and 6 false negative cases with 2 inconclusive reports. There were no false positive cases detected by USG and FNAC. Thus, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy for USG was found to be 92, 100, 100, 93.75, and 96.36% (χ2-value = 94.88, p-value = 0.0001,S) and values of 88.68, 100, 100, 91.04, and 94.73% were obtained for FNAC respectively (χ2-value = 92.04, p = 0.0001,S). Conclusion: In diagnosing malignant breast lesion, USG and FNAC are 100% specific. Although USG appears more sensitive than FNAC, the percentage of indeterminate report is higher with USG.