Diagnosis Of Palpable Breast Lesions Research Articles

Diagnostic Usefulness of Tru-Cut Needle Biopsy in the Diagnosis of Palpable Breast Lump

Introduction: Tru-cut biopsy is now one of the useful means of obtaining early and accurate histopathological diagnosis. It is easy and can be performed on an outpatient basis. It also avoids unnecessary excisional biopsy. Objective: To correlate findings of trucut biopsy in Diagnosis of Palpable Breast Lesions. Material and Methods: A cross sectional, observational study of one years conducted in Dept. Of Surgery, Shaheed Suhrawardy Medical College & Hospital, Dhaka, Bangladesh from January to December 2017. The study includes 100 patients of palpable breast lump. Trucut biopsy was performed using a Tru-Cut gun BARD MAX-CORE with an 18-gauge needle by means of 4 successive insertions with different angulations of the needle into the lesion’s core. Results: The study includes 100 patients, Trucut Biopsy findings correlated with the histopathological findings in 97 of 100 cases (97.2%), which included 27 of 28 (96.4%) of the benign lesions and 71 of 72 (98.6%) of the malignant lesions. Conclusion: The results of this study suggest that TCB is an accurate, reliable and a safe method of establishing the diagnosis of cancer in patients with breast lesions. Our results yielded a high sensitivity of 95.65% with 96.88% specificity when compared with FNAC in the diagnosis of breast cancer especially when radiology is not diagnostic. Thus, trucut biopsy should replace fine needle aspiration in the preoperative assessment of suspicious breast lumps.

Diagnostic Accuracy of the International Academy of Cytology Yokohama System versus the Modified Masood’s Scoring Index in Categorization and Diagnosis of Palpable Breast Lesions

Introduction: Fine-needle aspiration cytology (FNAC) is a simple, minimally invasive, and effective tool that can be used to accurately diagnose benign and malignant lesions of the breast. The International Academy of Cytologists Yokohama system and Modified Masood’s Scoring Index (MMSI) are two important systems to categorize palpable breast lesions on FNAC. The goal of the present study was to evaluate the IAC Yokohama system and MMSI in the cytological diagnosis and classification of diverse breast lesions and to compare the diagnostic accuracy of both systems through cyto-histological correlation. Methods: A retrospective cross-sectional study was done within the 3-year period from 2019 to 2021. Seven hundred and ninety cases of FNAC breast lesions were included and were categorized following the recommendations by the International Academy of Cytologists Yokohama system and MMSI. The sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy for both systems were calculated, taking histopathology as the standard. Additionally, the risk of malignancy (ROM) of each category was calculated in the Yokohama system. Results: The IAC Yokohama system’s sensitivity, specificity, PPV, NPV, and diagnostic accuracy were 96.8, 95.8%, 96%, 96.6%, and 96.3%. The MMSI had sensitivity, specificity, PPV, NPV, and diagnostic accuracy of 95.8%, 98.4%, 98.3%, 96.1%, and 97.1%, respectively. The ROM for insufficient, benign, atypical, suspicious for malignancy, and malignant categories were 12.5%, 1.8%, 20%, 90.4%, and 97.5%, respectively. Conclusion: The categorization of breast lumps using the MMSI is more accurate and more specific in diagnosing malignant cases, and thus, the MMSI system is more precise and accurate at diagnosing malignant cases.

CYTOMORPHOLOGICAL PATTERNS OF PALPABLE BREAST LESIONS DIAGNOSED ON FINE NEEDLE ASPIRATION CYTOLOGY

ABSTRACT: Background: Fine Needle Aspiration Cytology (FNAC) is a simple, minimally invasive, cost effective and outpatient based method for diagnosis of various palpable lesions. Breast cancer is the commonest malignancy in women worldwide and adequate preoperative evaluation is the most essential part of management of breast lumps. Although core needle biopsy has evolved as the diagnostic tool of choice for breast lumps, Fine Needle Aspiration Cytology still remains an important diagnostic tool. Material & Method: We have conducted retrospective study of FNAC of palpable breast lumps for period of one year (June 2020 to May 2021) in Pathology department at Shantabaa Medical College and General Hospital, Amreli. All patients were out patient based from surgical OPD. A total of 46 FNACs from palpable breast lesions were studied. Results: Out of 46 FNACs, 25 were benign, including infective etiology, 12 were suspicious for malignancy, 9 were malignant. Conclusion: FNAC serves as a rapid, economical and reliable tool for the diagnosis of palpable breast lesions. Cytopathological examination of lesions before operation or treatment serves as an important diagnostic modality.

The cyto-histopathological evaluation of breast lesions in a tertiary care hospital- A two years study

The cyto-histopathological evaluation of breast lesions in a tertiary care hospital- A two years study - ACHR- Print ISSN No: - 2581-5725 Online ISSN No:- 2456-9267 Article DOI No:- 10.18231/2456-9267.2019.0007, IP Archives of Cytology and Histopathology Research-IP Arch Cytol Histopathol Res

Diagnostic Usefullness of Trucut Biopsy in Diagnosis of Palpable Breast Lesions

Diagnostic Usefullness of Trucut Biopsy in Diagnosis of Palpable Breast Lesions

Triple Test Approach for Diagnosis of Palpable Breast Lesions

Introduction: Management of breast diseases is a multidisciplinary endeavor dependent on skill and expertise of an array of clinical specialists. Study evaluates efficacy of the individual components of triple test in diagnosis of palpable breast lesions. Materials and Methods: Present study was a hospital based prospective study done over a period of 2 years and included 100 female patients with palpable breast lesions in a tertiary care hospital at Telangana. Detailed clinical history and physical examination was done, followed by mammography, fine needle aspiration cytology. The histopathological report was considered the reference standard. Results: Triple test is the combination of clinical examination, mammography and fine needle aspiration cytology. If all the 3 tests were benign then triple test was concluded as benign, and if all 3 tests were malignant then it was concluded as malignant. Triple test revealed 97.29% sensitivity and 98.41% specificity, with 1 false positive and false negative each. Triple test was scored as concordant if all the 3 tests, had either all malignant or all benign results. Triple test was scored as nonconcordant if all the 3 tests had neither all malignant nor all benign results. Triple test was concordant in 82 (82%) cases. Conclusion: Triple Test is a powerful clinical tool that is, easy to perform, minimally invasive, and provides rapid, cost­effective, reliable, and accurate diagnosis of breast malignancies. Triple Test Score is safe and efficacious for establishing diagnosis and managing the ever­increasing number of patients presenting with breast masses.

English

BACKGROUND: Malignancy of breast imposes significant reduction in life span. The prognosis of breast cancer is primarily dependent on the extent of disease and also early diagnosis in important. FNAC is a widely accepted cytological technique in the early diagnosis of palpable breast lesions. There have been many studies of accuracy of FNAC, which has been shown to be high in many centres. AIMS: To compare cytological and histopathological diagnosis of breast lesions and to establish accuracy of aspiration cytology as an early diagnostic aid. SETTINGS & DESIGN: This prospective study was conducted at our hospital on a study population of 66 female patients over a period of 1 year from 2010 to 2011. MATERIAL AND METHODS: 66 female patients presenting with palpable breast lesions were included. Males, pediatric age group and non-palpable breast lesions were excluded. FNAC was done in all cases and a comparison was made between clinical, cytologic and histopathologic results. CONCLUSION: FNAC is a simple, rapid procedure, which has got high level sensitivity and specificity in diagnosing breast lesions and should be a compulsory investigation before any definite therapeutic procedure is instituted.

Validity of fine needle aspiration cytology of the palpable breast lesions: A teaching hospital experience

Background and Objective: Fine needle aspiration cytology has assumed a great importance in the pre-operative diagnosis of palpable breast lesions in several hospital and clinical settings worldwide. This study aims to audit its diagnostic utility and validity in a tertiary hospital, and to review some of the diagnostic pitfalls in interpretation of breast cytology. Materials and Methods: The study comprised of breast cytology reports and their subsequent tissue biopsy diagnoses recorded over a 5-year period from January 2008 to December 2012. Results: A total of 1162 breast cytology reports were made over the review period out of which 200 had histological confirmation. Out of the 200 cases, 109 (54.5%) were benign (C2), 20 (10.0%) cases were suspicious probably benign (C3), 27 (13.5%) cases were suspicious probably malignant (C4) and 44 (22.0%) were malignant (C5). The cytology reports were correlated with subsequent histological diagnoses. Of the 109 benign C2 reports, 99 were confirmed on tissue histology as truly benign (true negatives) and the remaining 10 cases were malignant (false negatives). Forty-three of the 44 malignant (C5) cytology reports initially made were confirmed as malignant on tissue histology (true positives). The remaining malignant (C5) cytology case was, however, revealed to be benign (false positive). The overall suspicious rate (C3 and C4) was 23.5%. The absolute sensitivity was 81.0%, specificity was 99.0%, positive predictive value (PPV) (C5) of 97.7%, negative predictive value (NPV) (C2) of 90.8%. The false positive rate (FPR), false negative rate (FNR) and suspicious rates (SR) were 1.2%, 12.0% and 23.5%, respectively. Conclusion: Fine needle aspiration cytology of the breast has recorded high absolute sensitivity and specificity in our centre with a marginally high false positive rate. It has thus continued to have relevance as an important pre-operative diagnostic tool in the management of palpable breast lesions in our hospital.

Fine Needle Aspiration Cytology of Palpable Breast Lump: A Study of 1778 Cases

Background: Breast carcinoma is the most common malignant tumour and the leading cause of death from cancer in women. A large number of patients in Bangladesh have been suffering from breast cancer. Now-a-days, FNAC is being performed as a pre-operative test to evaluate breast lump. FNAC is cost effective and can prevent unnecessary surgery. As FNAC became more reliable in diagnosing malignancy and thereby the use of frozen-section histology had been reduced by about 80%. This study intended to look the frequencies of different lesions in FNAC of palpable breast lump. Methods: FNAC was done in a total of 1778 female patients presented with palpable breast lump along with suspected enlarged axillary lymph node, if any. We assessed the age of the patient, lesion size, site, type of lesion and axillary lymph node metastasis in case of malignancies. Results: Age ranges from 14-86 years with a mean age of 33.6 years. Most of the patients were in 21-30 years age group (38.13%). Among the lesions 508 (28.57%) fibroadenoma, 252 (14.17%) carcinoma, 210 (11.81%) fibrocystic changes, 141 (7.93%) abscess, 116 (6.52%) granulomatous lesion, 113 (6.3%) chronic mastitis were identified. 218 (42.91%) of fibroadenoma and 82 (32.54%) of carcinoma were in the age group 21-30 years and 31-40 years respectively. Mean lesion size was 4.3 ± 2 cm. Site distribution in different cases is almost equal. 116 of carcinoma patient were presented with palpable lymph node and showed metastasis in 26 (10.32%) cases. Conclusion: FNAC serves as a rapid, economical, and reliable tool for the diagnosis of palpable breast lesions because the cytopathological examination of these lesions before operation or treatment, serves as an important diagnostic modality. Fibroadenoma was the commonest lesion in this study. However, malignancy was detected as the second common lesion.

Use of Fine-Needle Aspiration in the Evaluation of Breast Lumps

Background. A study was designed to see the role of fine needle aspiration cytology (FNAC) in palpable breast lumps. Materials and Methods. Four hundred and twenty five (425) patients came to the Department of Pathology King Edward Medical University, Lahore in four years for FNAC of their palpable breast masses from June 2006 to June 2010. FNAC diagnosis was compared with histological diagnosis to see the accuracy of fine needle aspiration cytology for neoplastic lesions. Results. There were 271/425 benign, 120/425 malignant, and 32/425 suspicious smears. Inadequate samples were repeated twice or thrice, and the degree of success was improved with consecutive repeating approaches. The frequency of inadequacy declined from 86 to 18, and 2 for first, second and third attempts, respectively. The number of repeats increased the diagnostic accuracy of aspirates which is statistically significant (P = .000). Invasive ductal carcinoma was the most commonly reported lesion with maximum incidence in the 4th, 5th, and 6th decades followed by invasive lobular carcinoma and other malignant lesions. The sensitivity, specificity, accuracy, negative predictive value, and the positive predictive value of FNAC was 98%, 100%, 98%, 100%, and 97%, respectively. Conclusion. FNAC serves as a rapid, economical, and reliable tool for the diagnosis of palpable breast lesions because the cytopathological examination of these lesions before operation or treatment serves as an important diagnostic modality.

The clinical effectiveness of fine needle aspiration biopsy in patients with palpable breast lesions seen at the University College Hospital, Ibadan, Nigeria: A 10-year retrospective study

Background:Although open surgical biopsy is the ‘gold standard’ for diagnosis of palpable breast lesions, in recent years two types of minimally invasive breast biopsy techniques, core needle biopsy and fine needle aspiration biopsy (FNAB), have become established for the diagnostic evaluation of palpable breast lesions.Aims:This study was undertaken to evaluate the clinical effectiveness of FNAB as a first line diagnostic procedure in the management of patients with breast lumps in University College Hospital (UCH), Ibadan, using the suggested thresholds for cytology performance as recommended by the United Kingdom National Health Services Breast Screening Programme (NHSBSP).Settings and Design:A 10-year retrospective cohort study carried out in the Pathology Department of UCH.Materials and Methods:All FNAB and histologically diagnosed cases of breast lesions in the pathology department between January 1996 and December 2005 were reviewed. The cytological diagnoses were then categorized into one of five diagnostic categories in accordance with the recommendations of the NHSBSP.Results:The positive predictive value for malignancy was 99.3% with a complete sensitivity of 97.7% and specificity (full) of 94.2%.Conclusions:The high quality assurance measures obtained in this study affirms FNAB as a clinically effective diagnostic procedure for breast lesions.

Accuracy of the “Triple Test” in the Diagnosis of Palpable Breast Masses in Saudi Females

For patients who present to clinicians with palpable breast lesions, the triple test: (physical examination, mammography and fine-needle aspiration cytology) can be employed to provide accurate diagnosis. In this study, the sensitivity, specificity and predictive values of triple test components were studied separately and in combination. During the study period (from January 1998 to December 1999), 140 patients with palpable breast masses were subjected to all components of the triple test followed by confirmatory open biopsy. Physical examination showed 82.6% sensitivity, 97.3% specificity and 86.4% positive predictive value. Mammography showed 87.5% sensitivity, 97.3% specificity and 87.5% positive predictive value and fine-needle aspiration cytology (FNAC) showed 91.7% sensitivity, 100% specificity and 100% positive predictive value in concordant cases (elements had either all malignant or all benign results). The triple test was 100% accurate in the diagnosis of palpable breast lesions when all three elements were concordant. Based on these results, we recommend elimination of the confirmatory open biopsy, which will result in reduced expenses and morbidity compared with open biopsy.

Tru-cut biopsy of palpable breast lesions: a practical option for pre-operative diagnosis in developing countries.

To establish the role of Tru-cut needle biopsy in the pre-operative diagnosis of breast lesions in a developing country. Prospective cross sectional study. 112 consecutive patients with palpable breast lesions who had both Tru-cut and excision biopsy as a pre-operative diagnostic procedure. Four (3.6%) patients had specimens that were inadequate for histological diagnosis. Tru-cut biopsy diagnosed 42 of the remaining 108 as malignant and 66 as benign, but only 40 and 61 respectively were confirmed to be correctly so by excision biopsy. Tru-cut biopsy, therefore, achieved a sensitivity of 88.9% (95% CI 79.7 to 98.1) specificity of 96.8% (95% CI 92.5 to 100) and an over all diagnostic accuracy of 93.5% (95% CI 88.9 to 98.2). There was a false positive rate of 4.8%, a false negative rate of 7.6% and a positive predictive value of 95.2%. The pathologist was able to make a correct specific histological diagnosis in 76.2% of all the adequate Tru-cut samples. If Tru-cut biopsy is done instead of excision biopsy, it will sufficiently reduce waiting time and reduce cost (four fold). It is well tolerated by patients. We regard the procedure as a useful adjunct and indeed a practical option for accurate pre-operative diagnosis of palpable breast lesions.

FNAC in the diagnosis of symptomatic breast cancer: a reminder

Fine needle aspiration cytology (FNAC) of 138 symptomatic breast cancers achieved complete sensitivity 97.8%, absolute sensitivity 90.6%, and positive predictive value (C5 diagnosis) 99.2%. The efficiency and other advantages of FNAC in the diagnosis of palpable breast lesions should not be forgotten in the current vogue for core needle biopsy.

Use of the “Triple Test” for palpable breast lesions yields high diagnostic accuracy and cost savings

The "triple test" for palpable breast lesions consists of physical examination, mammography, and fine-needle aspiration. Forty-six lesions in 43 patients were subjected to all three components of the triple test, followed by confirmatory open biopsy. In all 21 cases where the triple test was concordant (elements had either all malignant or all benign results), pathologic analysis of open biopsy samples was confirmatory (predictive value and sensitivity 100%). Fine-needle aspiration was the most reliable element of the triple test in cases where the elements of the test were nonconcordant (negative predictive value and sensitivity of 95% and 96%, respectively). The triple test was 100% accurate in the diagnosis of palpable breast lesions when all three elements were concordant. Cost analysis revealed that elimination of confirmatory open biopsy in such cases and also in cases in which the fine-needle aspiration and one other element of the test had a suspicious or malignant result, could yield an average per-case cost savings of up to $1,412 compared to triple test followed by routine confirmatory open biopsy.

Diagnostic Accuracy, Cost-Effectiveness, and Triage Role of Fine-Needle Aspiration Biopsy in the Diagnosis of Palpable Breast Lesions

Diagnostic Accuracy, Cost-Effectiveness, and Triage Role of Fine-Needle Aspiration Biopsy in the Diagnosis of Palpable Breast Lesions

The palpable breast nodule. A cost-effectiveness analysis of alternate diagnostic approaches

Traditionally, open biopsy has been considered the optimal procedure for the diagnosis of breast nodules. Fine-needle aspiration biopsy (FNAB) has been proposed as an alternate method for the diagnosis of many palpable breast lesions. The authors compared the diagnostic utility of open biopsy and FNAB using decision tree and cost-effectiveness analyses. When compared with two-step excisional biopsy, FNAB achieved a savings of over $700 at the cost of 0.1% decrease in 10-year overall survival. These data indicate FNAB to be a reasonable alternative to open biopsy for the diagnosis of palpable breast lesions in many patients.