Breast Fine Needle Aspiration Cytology Research Articles

Application of International Academy of Cytology Yokohama System for Reporting Breast Fine Needle Aspiration Cytology- A Retrospective Study

Introduction: Fine Needle Aspiration Cytology (FNAC) is a rapid, minimally invasive and cost-effective procedure with a high sensitivity rate of 92-95% and high Positive Predictive Value (PPV) approaching 100% for the diagnosis of breast malignancies. International Academy of Cytology (IAC) Yokohama system for reporting breast FNACs had been established in 2016 to bring consistency and uniformity of breast cytology reporting. Aim: To classify the breast lesions according to the IAC Yokohama system for cytological reporting of breast lesions. Materials and Methods: This was a retrospective six years study carried out in the Department of Pathology, Karpaga Vinayaga Institute of Medical Sciences, Chinnakolambakkam, Tamil Nadu, India. All females breast FNAC cases reported during the year January 2015 to December 2020 were included in the study according to the inclusion criteria. Relevant clinical and pathological data including the FNAC reports were retrieved from the medical records of the department. Corresponding FNAC smears stained with Haematoxylin and Eosin (H&E) and Papanicolaou stains were reviewed and double-checked with the FNAC reports. All those cases were grouped according to the IAC Yokohama System. Statistical analysis was carried out using Statistical Package for the Social Sciences (SPSS) version 23.0. Results: Of the total 381 female breast FNACs, majority (60%) of them belonged to the age group of 21-40 years. The predominant presenting symptom was palpable breast lump (73%) and Upper Outer Quadrant (UOQ) was involved in 65% of cases. Out of 381 cases, 297 (78%) were benign, 52 (13.6%) were malignant and 32 (8.4%) were inadequate for diagnosis. Total 73.8% cases belonged to “C2” category and fibroadenoma was the most prevalent lesion. Pearson Chi-square test showed highly significant association between patient’s age above 40 years and the risk of having a malignant breast lesion (p<0.0001). Conclusion: FNAC is an effective diagnostic modality for preoperative diagnosis of breast lesions thereby facilitating proper treatment at an early stage of the disease. Also adherence to the standardised cytological reporting system like IAC Yokohama system will ensure quality assurance across various institutions, thereby strengthening the healthcare services.

Triple Assessment for the Diagnosis of Carcinoma Breast in a Tertiary Care Hospital of Tripura: A Cross-sectional Study

Introduction: A combination of invasive and non-invasive procedures, clinical examination, radiological imaging (mammography/ ultrasonography/ Magnetic Resonance Imaging (MRI)) and fine needle aspiration cytology called the triple assessment test is being increasingly used in place of the more invasive core needle biopsy and histopathology. Aim: To evaluate accuracy of triple assessment in the preoperative diagnosis of patients with breast carcinoma and to determine sensitivity and specificity with regards to histopathology in the diagnosis of the disease. Materials and Methods: A cross-sectional study was conducted among 61 women of more than 25 years of age having palpable breast lump, attending the surgery Outpatient Department (OPD) and breast clinic of a tertiary care hospital from January 2017 to February 2019. Data on socio-demographic status, menstrual and obstetric information, clinical examination performed, mammography, Fine Needle Aspiration Cytology (FNAC), High resolution sonography breast and histopathology were recorded into predesigned and pretested proformas and analyzed using Statistical Package for Social Sciences (SPSS) version 25.0. Results: Out of total 61 patients participated in the present study, most patients were of 41-50 years of age, with a mean age of 44.23±7.37 years, married, non-vegetarian and without any past history of alcohol consumption. Sensitivity and specificity of triple assessment was 98.3% and 100% respectively. The positive predictive value of Triple Assessment was 100% while the negative predictive value was 66.7%. All values were significantly better than both clinical breast examination and FNAC in detecting malignancies. Conclusion: The triple test was also found to be as accurate in diagnosing breast carcinoma in this geographical region. A patient with a negative triple test report can be safely followed up without the need for biopsy.

Genç Bir Erkekte Semptomatik Benign Meme Kisti

Simple breast cysts are benign lesions diagnosed in premenopausal women commonly presenting with a palpable breast lump. They are however, extremely rare in males due to the absence of lobular tissue in the male breast. We report a case of a benign breast cyst in a 19-year-old male who presented with a left breast lump and nipple discharge. Clinical examination revealed a non-tender 2x2 cm mobile retro-areolar lump in the left breast with clear serous nipple discharge upon milking of the duct. Ultrasonography showed typical features suggestive of a simple breast cyst and fine needle aspiration cytology revealed epithelial cells of apocrine origin, thus confirming the diagnosis. We review the literature and discuss the approach to investigation of these uncommon lesions presented in males.

How Accurately FNAC Reflects the Breast Papillary Lesions?

Context:Diagnosis of papillary lesions of the breast by fine needle aspiration cytology (FNAC) is problematic. For this reason, it is situated in the indeterminate zone in classification systems.Aims:To ascertain the accuracy of cytological diagnosis of papillary lesions in distinguishing papillary lesions from non-papillary lesions and to determine whether papillomas can be reliably distinguished from malignant papillary lesions by FNAC.Material and Methods:A total of 346 cases with the diagnoses of breast papillary lesions were selected among 5112 breast FNAC procedures performed in our center. One hundred and thirty-nine cases with excised lesions were included in this study, and their corresponding histology was reviewed.Results:Papillary lesion diagnosis was confirmed by histopathology in 103 (74.1%) of 139 patients. Cytology and histopathology results were not found to be compatible in 35 (25.2%) cases. The diagnostic accuracy of distinguishing papillary breast lesions as malignant or benign was assessed statistically. According to the cytology–histology comparison, one case was evaluated as false negative (FN) and twelve cases as false positive (FP). Overall accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of FNAC in distinguishing papillary lesions as benign or malignant were calculated as 87%, 97%, 83%, 72%, and 98%, respectively.Conclusions:The diagnostic accuracy of papillary breast lesions classified by FNAC might be improved by careful evaluation together with cytological, radiological, and clinical findings (triple test). Cell block may allow more accurate evaluation of the papillary lesion and can be applied to immunohistochemical examination. It may also facilitate the differentiation of benign/malignant papillary lesions.

Cytohistological Correlation of Palpable Breast Lesions in a Tertiary Care Centre – A Retrospective Study

Background: Breast cancer is one of the leading causes of death from cancer among women. WHO reported that around 1lakh new cases of carcinoma breast are diagnosed every year in India and about 70,218 deaths due to breast cancer was estimated in Indian women every year. Early diagnosis and prompt treatment plays an important role in decreasing the mortality due to breast cancer. Presenting complaint in majority of the cases is a palpable lump in the breast. Fine needle aspiration cytology (FNAC) is a simple, fast, inexpensive method and reliable. It is being used as a first line procedure for diagnosing breast lesions
 Aim: This study is aimed to examine the cytological features of FNAC done on palpable breast lesions and to correlate the results of these breast FNAC with the corresponding tissue biopsy reports. Thereby we are determining the accuracy of reporting FNAC breast lesions in our hospital.
 Material and Methods: This is a 1-year retrospective study of breast lumps seen in Department of Pathology, Saveetha Medical College, Chennai. All patients who had FNAC of breast lumps with subsequent histological confirmation over this period are included in this study. Cytological diagnosis was categorized as benign, inflammatory, suspicious for malignancy, positive for malignancy and inadequate and compared with histopathological diagnosis for correlation. Statistical analysis was done to test sensitivity specificity, positive predictive value and accuracy.
 Results: This is a 1-year retrospective study of breast lumps seen in Department of Pathology, Saveetha Medical College, Chennai. All patients who had FNAC of breast lumps with subsequent histological confirmation over this period are included in this study. Cytological diagnosis were categorized as benign, inflammatory, suspicious for malignancy, positive for malignancy and inadequate and compared with histopathological diagnosis for correlation. Statistical analysis was done to test sensitivity specificity, positive predictive value and accuracy
 Conclusion: FNAC is a quicker, easier, inexpensive, safe and readily acceptable procedure. Though definitive specific diagnosis may not be possible by cytology, but it can be categorized and differential diagnosis can be derived. So, to conclude, Aspiration cytology can be done as a first line procedure but cannot be considered as a substitute for histopathology.

A prospective study and correlation of cytological, cell-block and histopathological diagnosis of breast lesions

Breast carcinoma is the second most common cancer in the world and establishing an early diagnosis is clinically very important. Fine needle aspiration cytology (FNAC) is the fast, reliable and ideal initial diagnostic modality for the diagnosis of these lesions.This is a cross-sectional prospective study of 12 months duration. A total of 160 patients underwent FNAC of palpable breast lump/lumps. A cell-block preparation was done for 80 cases and the histopathological examination has been performed on all the 160 cases.The cytomorphological diagnosis, cell-block diagnosis and histopathological diagnosis were correlated using suitable statistical methods.Out of 160 patients, on cytological examination, 107 cases (67%) were benign and 53cases (33%) were malignant. On histopathological examination, 104 cases (65%) were benign and 56 cases (35%) were malignant. On examination of cell block, two cases which were indeterminate in FNAC turned out to be malignant.FNAC plays a main diagnostic role as an out-patient procedure which gives rapid diagnosis. FNAC when combined with cell-block can give more accurate diagnosis.

Breast FNA cytology reporting using new proposed IAC Yokohama reporting system: A single institution retrospective study

Introduction: Breast lumps are a common presenting complaint in general practice. Breast cancers are the most common cancers diagnosed over the world along with unfortunate rise in number of mortality due to them. Proper diagnostic evaluation is necessary. The fine needle aspiration cytology (FNAC) examination of breast lumps is important as it can be used either to differentiate between benign and malignant breast lesion or as an adjunct to core needle biopsy. In 2016 the IAC Yokohama five category reporting system was proposed to allow uniform reporting of breast FNA aspirates. Aim: The current study aims to reclassify breast lump aspirates using the proposed Yokohama reporting system and also to assess the risk of malignancy of each category. Materials and Methods: This single institution retrospective study included female breast lump FNAC cases over 4 year period. Clinical details of included cases were recorded from archives. Cytology slides were reevaluated as per new reporting system and the histopathology correlation was done where available. Statistical analysis was performed. Risk of malignancy of each category was calculated. Results: 649 breast FNAC cases were studied of average age 36.97 years. Maximum cases were in benign category followed by malignant category. Fibroadenoma was most common benign diagnosis. The risk of malignancy was 3.17% in benign category and 95.45% in suspicious for malignancy category. The diagnostic accuracy in current study was 97.83%. Conclusion: Use of a standard categorical cytology reporting system will give improved reports for better patient care.

A retrospective analysis of 512 cases of breast fine needle aspiration cytology utilizing the recently proposed IAC Yokohama system for reporting breast cytopathology.

Recently the International Academy of Cytology (IAC) introduced a new reporting system for breast fine-needle aspiration cytology that classifies cytologic diagnoses into five-categories: (I) insufficient material, (II) benign, (III) atypical, (IV) suspicious of malignancy, and (V) malignant. The current study was undertaken to categorize the breast lesions utilizing the newly proposed IAC Yokohama classification system and evaluate the risk of malignancy (ROM) for respective categories and the diagnostic yield of this technique. All FNAs of breast lesions over 2.5 years were categorized retrospectively using the newly proposed IAC Yokohama reporting system. The ROM was calculated along with sensitivity, specificity, positive and negative predictive value, diagnostic accuracy, false positive, and false-negative rate using the histological diagnosis as the gold standard. The 512 cases were distributed as follows: Category I (insufficient material) 7.4%, Category II (benign) 74%, Category III (atypical) 5.7%, Category IV(suspicious) 1.4%, and Category V (malignant) 11.5%. Histopathological correlation was available in 285 (55.7%) cases. The respective ROM calculated was 33.3%, 0.5%, 13.3%, 83.3%, and 100% for Category I-V. The Sensitivity, Specificity, Positive and Negative Predictive Value, and Diagnostic accuracy were 95%, 99.5%, 98.27%, 98.6, and 98.5% respectively. Despite previous attempts to establish a standardized diagnostic terminology, there has been a lack of a single internationally approved standardized reporting system allowing substantial diagnostic clarity and incorporating distinct diagnostic categories, each linked with a specific ROM and recommended management. This System also provides enhanced communication between pathologists and attending clinicians for the benefit of the patient.

Effectuation of International Academy of Cytology Yokahama Reporting System of Breast Cytology to Assess Malignancy Risk and Accuracy.

Introduction:Recently the International Academy of Cytology (IAC) proposed a new Yokahama reporting system for breast fine-needle aspiration cytology (2019) in order to standardize reporting pattern and to link cytology reporting to management algorithms.Aims and Objectives:To categorize the samples according to the newly proposed IAC Yokahama reporting system of breast cytology and to assess diagnostic accuracy and corresponding risk of malignancy (ROM) for each category.Materials and Methods:This is a retrospective study of breast cytology cases done at Department of Pathology. The slides are retrieved from pathology archives and classified using a recently proposed IAC, Yokahama reporting system of breast cytology into five categories. The risk of malignancy, sensitivity, specificity, and diagnostic accuracy were estimated on the basis of the final histopathological diagnosis.Results:Of the 386 cases of breast FNAC, 226 (55.55%) had the corresponding histological diagnosis. The respective ROM for each category was 22.22% for category 1 (insufficient material), 5.32% for category 2 (benign), 26.31% for category 3 (atypical), 100% for category 4 (suspicious for malignancy), and 100 % category 5 (malignant). Malignant cases were considered only when positive tests, the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were 89.66%, 100%, 100%, 90.2%, and 94.69%, respectively.Conclusions:The present study showed statistically significant sensitivity, specificity, and diagnostic accuracy, especially with malignant cases. Hence, using the IAC Yokahama reporting system of breast cytology is effective to standardize the reporting in various institutes and provide clear guidelines to clinician for further management.

International Academy of Cytology Guidelines Based Categorization of Breast Fine-Needle Aspiration Cytology Lesions and their Histopathological Correlation

International Academy of Cytology Guidelines Based Categorization of Breast Fine-Needle Aspiration Cytology Lesions and their Histopathological Correlation

Cyto-Morphological Correlation of Indeterminate C3 (Atypical) and C4 (Suspicious) Categories in Fine Needle Aspiration Cytology of the Breast

In 1996, to harmonize the reporting system of breast lesions on fine-needle aspiration cytology (FNAC), National Cancer Institute (NCI) proposed five categories from C1-C5. C3 and C4 categories are noted to be ambiguous during histopathological correlation, hence “grey-zoned.” There have been limited researches regarding its usefulness and its histopathological correlation. This study was undertaken to evaluate C3 and C4 categories and to correlate with histopathological examination. This perspective and retrospective study was undertaken for two years. Forty cases of C3 and 32 cases of C4 were retrieved from a total of 602 cases of breast FNAC. Histopathological follow-up and correlation were available in 30 cases of C3 and 15 cases of category C4 and were selected for further study. On the histopathological correlation of the C3 category, 22 (73.3%) cases turned out to be benign, and 8 (26.7%) cases revealed malignant diagnosis, and among the C4 category, 2 (13.3%) cases revealed benign findings, and 13(86.7%) of the cases showed malignancy. This difference was statistically significant (P<0.001). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the C4 category in the diagnosis of malignancy were 61.9%, 91.6%, 86.6%, and 73.3%, respectively. FNAC is a simple, rapid, cost-effective, and accurate method to diagnose easily accessible breast swellings. However, one should be aware of its limitations as well. Our study supports maintaining C3 and C4 categories, as there was a statistically significant difference in benign & malignant diagnosis for these categories.

COVID-19 and breast fine needle aspiration cytology method: What should we change?

IntroductionAir‐dried slide preparation for fine needle aspiration cytology procedures is currently considered unsafe because of the risk of infectious aerosols of coronavirus 19. This study compares the safety and accuracy of two different protocols, one with and one without air‐dried slides.MethodsStarting from 3 March 2020, we discontinued the use of air‐dried slides during breast fine needle aspiration procedures. We selected cases collected during two periods: 2 months before and 2 months after 3 March. In both groups, the number of procedures was recorded together with the distribution of the diagnostic categories and the concordance between cytological and histological results on surgical specimens for lesions suggestive of malignancy, using the chi‐squared test.ResultsOf the 100 procedures performed during the pre‐COVID‐19 period, 55% were negative (C2), 3% were non‐diagnostic (C1) and 40% were positive (C4 or C5). Of the 75 procedures obtained during the COVID‐19 period, 44% were negative (C2), 2.7% were non‐diagnostic (C1) and 52% were positive (C4 or C5). Despite the use of a new protocol during the COVID‐19 period, we observed concordance between cytological and histological results for lesions suggestive of malignancy. There was no statistically significant difference concerning the distribution of the diagnostic categories in the two groups.ConclusionsTaking into account the slightly lower number of procedures being analysed during the COVID‐19 period, the introduction of a new protocol that does not include air‐dried slides is safe and reliable.

BFCNet: a CNN for diagnosis of ductal carcinoma in breast from cytology images

Fine Needle Aspiration Cytology (FNAC) is a quick and minimally invasive technique used to diagnose breast cancer, specifically ductal carcinoma. The incidence of breast cancer (ductal carcinoma) is high among Indian women. Consequently, there is a volume burden on laboratories, primarily regional centers, for diagnosis. The pressure on laboratories and doctors to make a timely and correct diagnosis can be resolved by automating the process to an extent, especially where expertise is limited. Recent advances in Artificial Intelligence techniques on large and complex data have enabled better understanding in the domain of Computer-Aided Diagnosis, which helps both automate and digitize diagnosis. In this study, we have leveraged Convolutional Neural Networks (CNNs) to automate the diagnosis of ductal carcinoma in breast from images produced after FNAC is performed on breast tissue. We created a data set of FNAC images of breast lesions and extracted 1020 Region of Interest (RoI) patches from Giemsa-stained lesions and 631 RoI patches from H&E-stained lesions. The performance of various CNNs was tested on these patches. Three networks performed very well and have the potential to assist doctors in diagnosis. One of them was a light network we built—BFCNet (Breast FNAC Classification Network). It produced the highest average accuracies in the binary classification of Giemsa-stained patches (97.53%) and H&E-stained patches (96.59%). This network fits the data properly and performs well in other parameters.

English

BACKGROUND In clinical practice, breast lump is a very common presentation of numerous breast diseases which ranges from benign cysts to malignant lesions. The difference between benign and malignant is very important for patient care and proper management. The diagnosis of breast lump includes clinical examination supplemented by imaging. Various literature has concluded that ultrasound evaluation with fine needle aspiration cytology (FNAC) correlation has comparable sensitivity and specificity to histopathology. Our aim was to study the ultrasonographic characteristics of breast lesions in patients and compare the sensitivity of ultrasonography in diagnosing benign and malignant breast lesions with FNAC. METHODS This is a diagnostic validation study, conducted at Department of Radiodiagnosis and Department of Pathology, Narayan Medical College and Hospital. All females more than 30 years coming for routine breast screening, found to have Breast Imaging Reporting and Data System (BI-RADS) 2 and above were subjected to ultrasonography and FNAC under ultrasonography (USG) guidance, and compared with histopathology. Data was collected, entered and analysed using Microsoft Excel, Epi Info, and SPSS software. Sensitivity and specificity with correlation, positive predictive value (PPV), negative predictive value (NPV) was calculated to compare the two diagnostic modalities. RESULTS USG had 83.3 % sensitivity, 97.56 % specificity, 95.24 % positive predictive value, 90.91 % negative predictive value, 33.32 % positive likelihood ratio and 17.13 % negative likelihood ratio. FNAC had 96.67 % sensitivity, 97.56 % specificity, 96.67 % positive predictive value, 97.56 % negative predictive value, 38.66 % positive likelihood ratio and 3.42 % negative likelihood ratio. CONCLUSIONS Breast ultrasound and FNAC both are important diagnostic tools for breast lesion. Sensitivity, specificity and other features are better for FNAC than ultrasound for breast lump. KEYWORDS Breast Lump, FNAC, USG, Adenocarcinoma, Squamous Cell Carcinoma

Demystifying Breast FNAC’s Based on the International Academy of Cytology, Yokohama Breast Cytopathology System- A Retrospective Study

Introduction: Breast cancer affects 2.1 million women each year and is the most common cancer among females, followed by lung, colorectum, uterus, and cervix. Breast cancer accounted for 6,26,679 (6.6%) deaths in 2018. Breast cancer incidence is on the rise in every part of the globe, including developed countries. Fine Needle Aspiration Cytology (FNAC) shows high sensitivity, specificity, and accuracy in evaluation of breast lesions. FNAC is part of the triple test and is the gold standard for assessment. The new reporting system for breast FNAC, proposed by the International Academy of Cytology (IAC) Yokohama Breast Cytopathology System, has standardised the reporting system to categorise breast lesions and as unmasked the diagnostic dilemma faced by reporting cytopathologist. Aim: The study aimed to categorise the samples according to IAC Yokohama Breast Cytopathology System and assess the Risk of Malignancy (ROM) for each category and increase the diagnostic yield of breast FNAC. Materials and Methods: A retrospective cohort study included 1,467 breast FNAC cases, which were retrieved and reclassified based on the newly proposed IAC Yokohama System into five categories during January 2017-December 2018 in Kidwai Memorial Institute of Oncology (KMIO), Bangalore. Histopathology correlation was done, and the Risk of Malignancy (ROM) was assessed whenever possible. The study results were analysed using Microsoft excel 2007, sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), and accuracy ratios were calculated using the MedCalc diagnostic test evaluation calculator, keeping histologic diagnosis as the gold standard. Results: Re-categorisation of 1,467 cases was done according to the Yokohama breast cytopathology system as insufficient material, benign, atypical, suspicious for malignancy, and malignant. The histopathology diagnosis was available in 1,069 cases. The respective ROM for each category was, 7.6% for category 1 (Insufficient), 15.26% for category 2 (Benign), 65.38% for category 3 (Atypical), 83.33% for category 4 (Suspicious) and 99.18% for category 5 (Malignant). Considering malignant cases as positive, sensitivity-86.75%, specificity-97.32%, PPV-99.19%, NPV-66.06% and accuracy of 88.96% was deduced. Conclusion: It is recommended to incorporate the IAC Yokohama system to categorise breast cytopathology with uniform terminologies. This will help diagnose breast lesions more consistently and accurately, which in turn helps the clinician manage the disease and predict the ROM and the patient outcome.

Quadruple Score: A Novel Scoring System for Diagnosing Breast Lump - A Retrospective Pilot Study.

Background:Triple test was a breakthrough in the initial screening of breast cancer due to its high sensitivity, but it has few limitations. To overcome those limitations, we developed a novel quadruple score which included physical examination, ultrasound, mammography, and fine-needle aspiration cytology (FNAC).Aim:The aim of this study was to test the sensitivity, specificity, negative predictive value (NPV), and positive predictive value of a novel quadruple score for the initial screening of breast cancer.Methodology:This retrospective study was conducted on 320 patients having breast lump to the Breast Cancer Outpatient Department of AIIMS, Bhopal. The physical examination findings, breast sonography findings, mammography, and FNAC findings were recorded in the set pro forma, these were later analyzed, and a cumulative scoring was done categorizing patients in the benign, dubious, and malignant category according to the QTS score. These findings were then validated and compared by histopathology.Results:Statistical results show a positive covariance σ suggesting the positive relation between them; also, the correlation coefficient was 0.9996 suggesting a strong linear correlation. On comparing the accuracy of all four variables as physical examination, USG, mammography and FNAC individually and QTS, the accuracy of QTS was highest i.e 99.44%.Conclusion:QTS is accurate and reliable diagnostic approach for evaluation of breast lumps. By using the quadruple scoring system, management of palpable breast lump will become more streamlined, providing a platform for managing discordant results, which can be followed universally.

Diagnostic Accuracy of Fine Needle Aspiration Cytology in Breast Masses among Children and Adolescents Aged Below 21 Years of Age- A Cross-sectional Study

Introduction: Breast diseases in paediatric and adolescence are unusual. Fine Needle Aspiration Cytology (FNAC) has an important role in triaging breast masses, more so in younger population, wherein preoperative accurate diagnosis has significant impact on selecting and planning treatment. Role of FNAC in breast lesions amongst children and adolescents has not been explored much. Aim: To study the role of FNAC in diagnosis of breast lesions in children and adolescents. Materials and Methods: A cross-sectional study was conducted between June 2017 to May 2019 at Adichunchanagiri Institute of Medical Sciences, Mandya, Karnataka, India. All the patients presenting with breast lesion aged below 21 years, referred to FNAC clinic during this period were included in the study. The diagnoses were categorised as inflammatory, benign, atypia, suspicious and malignant. Cytohistopathology concordance was attempted wherever possible. Analysis was done using Statistical Package for the Social Sciences (SPSS) software version 17.0. Results: Out of total 45 cases, 37 (82.22%) were females and 8 (17.78%) were males. Breast lesions in paediatric and adolescents accounted for 15.20% (45/296) of total breast FNAC performed during the study period. The morphologic spectrum seen most commonly was fibroadenoma (FA) 62.22% (2-8/45), benign breast disease 8.88% (4/45), mastitis 4.44% (2/45). Morphologic variations observed in FA were epithelial hyperplasia 32.14% (9/28), cystic change 28.57% (8/28), hyper cellular stoma 21.42% (6/28), multinucleate giant cells 32.14% (9/28), apocrine change 14.28% (4/28), adenosis 10.71% (3/28), columnar cell change 10.71% (3/28), squamous metaplasia 3.57% (1/28) and atypia 3.57%(1/28). Histopathologic correlation was obtained in 31 cases (68.88%). Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of FNAC was found to be 50, 100%, 100%, 96.6%, 96.77%, respectively. Conclusion: Majority of the breast lesions in paediatric and adolescents are benign in nature with FA being the most common. FNAC had high specificity and diagnostic accuracy, thereby establishing its role in selecting appropriate treatment for this age group of patients.

The diagnostic utility of cell block in fine needle aspiration cytology of palpable breast lesions in a Nigerian tertiary health institution.

Although fine needle aspiration cytology (FNAC) is highly accurate for detecting breast malignancies, concerns remain among cytopathologists about false-positive and false-negative diagnoses. Cell block (CB) preparations have been advocated by some cytopathologists as one of the methods to improve and consolidate the diagnostic accuracy of FNAC. The aim of this study was to determine the diagnostic utility of CB in FNAC of palpable breast lesions among female patients. Following FNA, CBs were prepared using 10% neutral-buffered formalin from the residual breast aspirates of 100 consecutive female patients attending the FNAC clinic. The slides of the conventional smears, CB and excisional biopsies were examined, and results were analysed using the SPSS. Of the 100 patients that had FNAC, 44 (44%) had excisional biopsy performed. An additional 13% diagnostic yield for malignancy was obtained with the use of CB preparations. CB reduced equivocal diagnoses by 25%, corresponding with 90.9% improvement on definitive diagnoses. In our setting, the addition of CB to smear remarkably improved the diagnostic utility of breast FNAC by minimising atypical and suspicious for malignancy diagnostic categories.

Correlation of Risk Factors with Different Reporting Categories of Fine Needle Aspiration Cytology (FNAC) of Palpable Breast Lumps

Background: Fine needle aspiration cytology (FNAC) is a well-known and valued technique for estimation of palpable breast masses before any surgery because it is highly sensitive, accurate, specific, and cheap. Most of the time, the risk factors are global, but sometimes there are some local, environmental, ethnic and genetic factors which could be different in different communities. Objective: To study different known risk factors of breast cancer in the population of Faisalabad and correlate it with FNAC categories and track significant factors in the local population. Study Design: Descriptive retrospective study. Settings: Meezan lab and University Medical and Dental College, Faisalabad Pakistan. Duration: June 2014- June 2019 (5 years). Methodology: A total of 1928 females with palpable breast lumps. FNA was done using a 23-gauge needle and results were interpreted by pathologists for adequacy and cellularity. Final cytological diagnoses were categorized as per United Kingdom National Health Services Breast Screening Program (NHSBSP) guidelines. The benign and malignant categories were correlated with risk factors like Age, Obesity, Genetic factors/ family history, contraceptives use, menstrual history, etc. All the collected information was analyzed using SPSS version-24. Frequency and percentages were measured for variables like FNAC categories and age. Risk factors were compared with benign and malignant categories and Chi-square test was used for correlation. Results: Out of 1928 cases, 469 (24.3%) were C5 (Malignant), and 1234 (64%) were C2 (Benign). For practical and treatment purposes both C2 and C3 were considered benign, comprising of 1357 (70.4%) cases and C4 and C5 were taken as malignant comprising of 571 cases (29.6%). Correlation of risk factors with Breast cancer revealed that following parameters were significant with P valve <0.05; Age 40-100 years, Obesity, Breast feeding, Active smoking, Married couple, Post menopause, Contraceptives not used and Malignant tumor history. On the other hand, Family history and radiation exposure were not found significant in the current study. Conclusion: Age ˃ 40, obesity, active smoking, post-menopausal status, breast feeding, marital status and malignant tumor history are the significant risk factors which are associated with breast FNAC categories of C4 and C5.

Application of Yokohama system for reporting breast Fine Needle Aspiration Cytology in correlation with histopathological and radiological findings

Background: Breast cancer is the leading cause of cancer deaths among women worldwide. Fine needle aspiration cytology (FNAC) and breast ultrasound are pivotal in characterization of a breast lump as benign and malignant lesion. The main objectives were to categorise the Breast FNAC samples according to new system of reporting and to assess the Risk of malignancy (ROM), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy for all categories. Methods: A Total of 900 FNAB cytology specimens from January 2017 to December 2018 were obtained. These were reclassified according to newly proposed IAC Yokohama system of reporting. The ROM, sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) and diagnostic yield of Breast FNAC and also of ultrasound were calculated. Result: Among 900 cases, 4.3% fall in category 1, 58%- category 2, 17.7%- category 3, 7.2%- category 4 and 12.8% - category 5, and correlated with corresponding radiological impression. Sensitivity, specificity, PPV, NPV and diagnostic accuracy of ultrasound were respectively 91.6%, 96.8%, 95.6%, 92.8%, 91.5% and those of FNAC respectively 94.59%, 98.9%, 98.59%, 95.74%, 96.97%. ROM is 5.0% for category 1, 1.2% for category 2, 12.5% for category 3, 93.65% for category 4 and 100% for category 5. Conclusion: IAC Yokohama system of reporting breast cytopathology serves as a common language to pathologist and clinician. Breast ultrasound is a non-invasive imaging-based technique and both these diagnostic tools can complement each other for patient diagnosis and management.