Cytolo-histological correlation of breast lump-as a part of internal quality control

Abstract

Introduction: Fine Needle Aspiration Cytology (FNAC) has gained increasing importance in the diagnosis of breast lumps especially it is an easy, non-invasive, simple procedure which can be done on OPD basis. The pre–operative diagnosis of breast lesions by FNAC is highly relied upon. However, there can be some cytological pitfalls in the diagnosis, especially when all the characteristic component of a lesion are not obtained in the aspirate, or when there is an overlap in the cytological features. Hence a review was undertaken with the following objectives. 1.        To correlate cytologic and histopathologic diagnosis of breast lesions as a part of internal quality control. 2.        To know the incidence of false positive and false negative cases. 3.        To find out the sensitivity and specificity of FNACof breast lesions. Methods: This study was conducted for a period of 3 years (April 2009 to March 2012) and 200 cases of fine needle aspirates of breast lumps studied. Out of which 126 cases were followed by histopathological correlation at pathology department; the cases are collected from Mahatma Gandhi Medical College & Research Institute, Sri Balaji Vidhyapeeth University; Pondicherry. Results: Out of 200 cases studied by FNAC, histopathological correlation was available for 126 cases. Cytological diagnosis in general was divided into four categories, benign (76.19%), malignant (15.08%), suspicious (5.56%), and unsatisfactory (3.17%). Maximum patients were in age group of 21 to 30 years. There were 119 female patients and 7 male patients. Fibroadenoma (69.79%) was most common benign neoplasm. There were 5 cases (5.21%) reported by FNAC as gynecomastia. After correlation with histopathology, there was 82.26% of correct diagnosis in all benign lesions.    There were 16 cases (84.21%) diagnosed cytologically as malignant and 3 cases (15.79%) as invasive duct carcinoma. Histopathologically all were confirmed as invasive duct carcinoma. Out of that one was reported in male breast. The incidence of false positive case was zero, false negative case was (1.59%). The diagnostic accuracy after histopathological correlation in malignant cases was 98.36%, sensitivity was 92.86% and specificity was 100%. Conclusion: To conclude, fine needle aspiration cytology is a fairly safe procedure in trained hands, and it gives reasonably accurate results, thereby helping the clinicians to plan the best line of treatment. Also with invention of imaging guided aspiration, FNAC went one step ahead in diagnosis of non-palpable lesion of breast. Thus a triple modality of clinical, mammographic and cytological correlation is required and for internal quality control FNAC is correlated with histopathology. Key Words: FNAC; Breast lumps; Breast neoplasm