Utility of fine needle aspiration cytology (FNAC) in diagnosis of papillary lesions of the breast

Abstract

Background: Diagnosis of lesions of the breast using Cytological screening is difficult. Understanding the common cytological features of papillary lesions of the breast can be useful for the diagnosis. Aims and objectives:To determine the utility of Fine Needle Aspiration Cytology (FNAC) in the diagnosis of papillary lesions of the breast Materials and methods: A retrospective study was performed from January 2010 to December 2015 in the cytology section, Department of Pathology of a tertiary care and referral hospital including patients diagnosed as papillary lesion on FNAC. Eight four cases were found (includes 44 cases which had histopathology follow-up, 36 cases which didn’t had follow-up), 4 cases were removed because of non-availability of slides. Thus, a total of 44 breast aspirates and their corresponding histology were reviewed. All the observations were done on total 44 cases. Results:Papillary Neoplasms on FNAC (n= 33): 13 cases (29.54%) were histologically confirmed as papillary neoplasms. All 13 cases (100%) showed true papillae with fibrovascular cores. 76% showed presence of columnar cells. 4 were benign and 9 malignant. Dyscohesion and severe atypia was only seen in malignant neoplasms. 20 cases were non papillary lesion on histopathology. Out of the 20 cases, 11 cases (55%) were infiltrating duct carcinoma (IDC), 4 were fibroadenomas (FA), 3 fibrocystic disease and one each was ductal carcinoma in situ (DCIS) and lobular carcinoma. Presence of papillaroid fragments and columnar cells was the most common cause for false positive diagnosis. Papillary Neoplasms Not Suspected Cytologically (n=11): In 5 cases cellularity was scanty and unsatisfactory for opinion. Missing fibrovascular cores in the aspirate was the cause of false negative diagnosis. The overall incidence of false positive was 25% and false negative was 13.75%. Sensitivity of FNAC to diagnose papillary lesions was 54.1%.Conclusion: Cytodiagnosis of papillary lesions is challenging and identification of true fibrovascular cores is essential for accurate diagnosis.