Diagnosis Of Palpable Breast Lump 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.

A Comparative Study Between Fine Needle Aspiration Cytology and Core Needle Biopsy in the Diagnosis of Palpable Breast Lumps

A Comparative Study Between Fine Needle Aspiration Cytology and Core Needle Biopsy in the Diagnosis of Palpable Breast Lumps

Diagnostic Accuracy of Mammographic and Sonographic Findings in the Differentiation of Palpable Breast Masses taking Histopathology as a Gold Standard

Background: The Presence of palpable breast mass may be an indication of breast cancer. Early and accurate diagnosis for the breast masses is important for therapeutic purpose.
 Purpose: To assess the diagnostic accuracy of mammographic and sonographic findings in the differentiation of palpable breast masses taking histopathology as a gold standard.
 Materials and Methods: 134 females were involved in the study. Sonographic and mammographic findings of palpable breast masses were obtained with the help of which diagnostic accuracy of ultrasound and mammography was calculated while taking histopathology as a gold standard.
 Results: Mean age in 134 females was found to be 44.2±4.7 years. Sn, Sp, PPV, NPV, disease prevalence and accuracy of ultrasound in diagnosis of palpable breast lumps were 99.09%, 79.17%, 95.61%, 95.00%, 82.09% and 95.52% respectively. Sn, Sp, PPV, NPV and accuracy of mammography in diagnosis of palpable breast lumps were 95.45%, 62.50%, 92.11%, 75.00% and 89.55% while disease prevalence was same as that of ultrasound i.e. 82.09% respectively.
 Conclusion: Ultrasound showed higher diagnostic accuracy in the evaluation of palpable breast masses than mammography while taking histopathology as a gold standard. It is noteworthy in differentiating breast masses.

The accuracy of ultrasound in diagnosis of palpable breast lumps

Objective: To find the sensitivity, specificity and positive predictive value of ultrasound in detection of palpable breast lumps and to correlate the findings of ultrasound with the findings of fine needle aspiration cytology (FNAC), or histopathology.Materials and Methods: Ultrasonagraphic evaluation of 100 palpable breast lumps was done in Alkhansaa hospital in the department of breast clinic. Diagnosis was made considering four features of the lumps i.e. shape, margins, width: AP ratio and echogenicity. Diagnosis was confirmed by fine needle aspiration cytology or histopathology.Results: The sensitivity of ultrasound in detection of palpable breast lumps was 95%. The incidence of breast lumps was highest in the age group of 20-29 years. Lump alone was the presentation in 75% of the cases. 60% of the lumps were present in outer upper quadrant of the breast. The sensitivity, specificity and positive predictive value of ultrasound in fibroadenoma of the breast was 82%, 94% and 90% respectively. The sensitivity for carcinoma of the breast was 67% and for cystic masses it was 92%. The ultrasound features that most reliably characterized breast masses as benign were round or oval shape (97% were benign), circumscribed margins (81% were benign) and width: AP ratio > 1.4 (90% were benign). Features that characterised masses as malignant were irregular shape (48% were malignant), non-circumscribed margins (36% were malignant) and width: AP ratio 1.4 (31% were malignant).Conculation: Ultrasound is a useful tool in differentiation of cystic from solid masses of the breast. It is useful in young females and pregnant women where mammography is not advisable. However its role in diagnosis of carcinoma of the breast needs further evaluation before it can be used for screening of carcinoma breast.

English

BACKGROUND The breast is composed of both specialised epithelial cells and stroma. Both benign and malignant lesions can occur in the breast as a palpable lump. Fine needle aspiration cytology (FNAC) is a rapid, easy to perform, minimally invasive and low cost first line high-diagnostic accuracy test for cytopathological evaluation of palpable breast lump with minimum complications. METHODS The study was carried out to evaluate the cytopathological patterns of 2706 palpable breast lumps by fine needle aspiration (FNA) procedure and cytohistopathological correlation of the available biopsied palpable breast lumps of the study in the Pathology department of Tezpur Medical College and Hospital, Assam, for a period of three years from July 01, 2016 to June 30, 2019. RESULTS Out of 2706 palpable breast lumps in the study, FNA smears of 19 (0.70 %) were inadequate for cytopathological reporting. Out of the remaining 2687 palpable breast lumps where FNA was adequate for cytopathological reporting, female patients (n = 2594) comprised 96.54 % and male patients (n = 93) comprised 3.46 % with a male and female ratio of 1:27.9. Out of the 2687 palpable breast lumps, 2318 were benign breast diseases (86.27 %) and 369 were malignant neoplasms (13.73 %), with a benign and malignant ratio of 6.28:1. Out of the benign breast lumps, fibroadenoma breast was seen in 1228 (52.98 %) and of the malignant neoplasms, infiltrating duct carcinoma was seen in 341 (92.41 %). Cytohistopathological correlation showed 98.70 % sensitivity, 99.38 % specificity, 99.35 % positive predictive value, 98.76 % negative predictive value, and 99.04 % diagnostic accuracy. CONCLUSIONS FNAC has high sensitivity and specificity in cytopathological diagnosis of palpable breast lumps. Based on the accurate cytopathological diagnosis of the palpable breast lumps, patients with palpable breast lumps can be given adequate treatment. KEYWORDS Fibroadenoma, Gynaecomastia, Duct Papilloma, Infiltrative Duct Carcinoma, Medullary Carcinoma, Mucinous Carcinoma, Malignant Phyllodes

FINE NEEDLE ASPIRATION CYTOLOGY AS A DIAGNOSTIC TOOL; AN ASSESSMENT

The study is about breast lesions which is a common cause of mortality and morbidity among females. To avoid negative consequences, there is need for urgent diagnosis and treatment. Fine Needle Aspiration Cytology (FNAC) is a useful diagnostic tool and possess higher level of accuracy. In this study, the objective was to determine the accuracy of FNAC in diagnosis of palpable breast lumps. Additionally, the objective was to find the correlation between cytological findings and histopathological examination of surgical specimens. The methodology of the study was based on retrospective study method. FNAC of breast lump was conducted on 271 patients out of which 104 formed the base group. The results showed that there were 104 patients of base study who had average age of 32 years. There were 54 patients with lump in left breasts, and 46 patients with lump in right breasts and 4 patient had bilateral lump. There were 77 patients with benign, 34 patients with malignant, and 3 had atypica;/suspicious lesions on cytological examination. Based on histopathological examination, 77 cases were related to benign, 26 were related to malignant, and 1 with atypical/suspicious. Cyto-histological concurrence was 93.05% and 79.2% for Fibroadenoma and Infiltrating ductal carcinoma respectively. Overall sensitivity of FNAC procedure was 94.17%, specificity 100% and accuracy 93.26%. On the basis of result, it is concluded that FNAC is a simple, reliable method for diagnosis of both benign and malignant lesions and can be used in the evaluation of breast lesions.

Role of Intraoperative Scrape Cytology in Diagnosis of Palpable Breast Lump

Background: Diseases of the breast constitute a significant proportion of surgical cases and frequently, the need arises to distinguish benign from malignant lesions prior to definitive treatment. So far, Frozen Section (FS) is the standard technique with high level of validity. However, intraoperative scrape cytology can be adopted when special facilities of FS are not available.
 Methods: This study designed with the aim to evaluate the value of Intraoperative Scrape Cytology (IOSC) in providing rapid and accurate diagnosis for breast lump and to compare its diagnostic yield with that of paraffin sections. This cross sectional descriptive study was carried out in the Department of Pathology, Chittagong Medical College in collaboration with Department of Surgery of this institution from October 2013 to September 2014. The study conducted on 123 patients with breast lumps who underwent operative treatment. Scrapings were taken from each specimen before formalin fixation and stained by rapid Papanicolaou staining. In each case their accuracy was compared to histopathological diagnosis. Statistical analysis done employing c2 test.
 Results: Out of 123 cases studied, 122 could be correctly differentiated into benign and malignant tumors with an accuracy rate of 99.19%.
 Conclusion: Intraoperative Scrape Cytology (IOSC) is a simple, accurate, rapid and cost-effective diagnostic tool, not requiring specific instruments in contrast to frozen section, can be used peroperatively for both diagnosis and management of breast lump.
 Chatt Maa Shi Hosp Med Coll J; Vol.17 (2); Jul 2018; Page 26-30

Clinical study of breast lump-triple assessment does help in diagnosing it better

Background: Breast cancer is most frequently diagnosed cancer among women and also most common cause of cancer death among women. Early stage detection is still low and is the major reason for poor treatment outcomes in our country. Most of the breast lumps are benign. However, it is important to rule out malignancy. This prospective clinical study is done to evaluate role of triple assessment (clinical examination, mammography and histopathology) in diagnosing breast lump.Methods: All women admitted with the symptoms and signs of breast lump at our hospital were studied in the period of 2 years from July 2014 to June 2016. The findings of physical examination and mammographic examination with histopathological diagnosis were noted n compared.Results: Physical examination of breast lumps is overall less accurate as compared to mammography. There is a tendency to over diagnose malignancy on physical examination. Mammography is more sensitive and specific in the diagnosis of palpable breast lumps as compared to physical examination. Histopathology confirms the diagnosis.Conclusions: It is better to do all three that is clinical examination, mammography and histopathology for all breast lumps diagnosis.

Study of Clinical Examination, Ultrasonography, Cytology Parameters in the Diagnosis of Palpable Breast Lump

Study of Clinical Examination, Ultrasonography, Cytology Parameters in the Diagnosis of Palpable Breast Lump

Fine needle Aspiration Cytology: Diagnostic Efficacy in Malignant Breast Lesions

Background: A palpable breast lump is a common problem encountered by both the general practitioner and the surgeon. FNAC is a rapid, simple, efficient and safe method for diagnosis of palpable breast lumps. It is very useful as a pre-operative diagnostic tool.The study was carried out to diagnose palpable lumps by cytology and to confirm them with histopathologic study wherever possible. Taking histopathology as the gold standard, the sensitivity, specificity and diagnostic accuracy of FNAC in all cases diagnosed as malignant by cytology were obtained. Methods: FNAC was performed in all patients who presented with a palpable breast lump & the cytological findings were recorded. Subsequent histopathologic study was done wherever possible on all cases reported as malignant or suspicious for malignancy on cytology. Result: A correlation of 97.67% was obtained in malignant lesions of the breast. Sensitivity was 100%; specificity and diagnostic accuracy were 97.67% each. Conclusion: FNAC as a diagnostic modality for palpable breast lumps is a very efficient, rapid, safe and inexpensive method. In spite of its limitations, FNAC offers a high rate of sensitivity and specificity which makes it a valuable tool for the preliminary diagnosis and management of breast lumps. DOI: 10.21276/APALM.1662

Fine Needle Aspiration Cytology of Palpable Breast Lumps - Their Cytological Spectrum and Histopathological Correlation

Background: With the advent of fine needle aspiration cytology (FNAC), the approach to diagnosis and management of breast lumps has been revolutionized and it has high sensitivity and specificity.Aim: In this study we analyze the spectrum of FNAC diagnoses in breast lumps and compare the diagnostic accuracy of fine FNAC in differentiating the benign and malignant lesions of breast lumps with histopathological correlation.Materials & Methods: Two years prospective study was conducted in our institution and in that 490 aspirations, including 6 bilateral were performed. Suppurative and inflammatory lesions were excluded from the total aspirates. The cytological diagnosis was classified into 3 groups benign, suspicious and malignant. After this reporting all the available 94 cases were later subjected to mastectomy or open/excision biopsy and followed-up by histopathological confirmation. Later diagnostic accuracy of cytology reporting was compared with that of histopathology.Results: A total of 490 FNAC cases were reported including 373 as benign, 4 as suspicious for carcinoma and 113 as carcinoma. Majorities were premenopausal females and commonest age group was 31-40 years. Among them only 94 cases were followed-up by histopathologic confirmation. In histopathological correlation study, we had accuracy rate of 100% for benign lesion and 92.10% for malignant lesion with false negative rate of 7.90% and false positive rate of zero with fine needle aspiration cytology in the diagnosis of palpable breast lump. The overall sensitivity of fine needle aspiration in diagnosing the palpable breast lump is 92.10%, specificity is 100%, positive predictive value is 100% and negative predictive value is 94.91%.Conclusion: FNAC in experienced hands is a very useful tool with very high specificity and rare false positive result. Sensitivity can be further improved with clinical and imaging correlation.KYAMC Journal Vol. 7, No.-2, Jan 2017, Page 780-786

Evaluation of modified triple test (clinical breast examination, ultrasonography, and fine-needle aspiration cytology) in the diagnosis of palpable breast lumps

Objective: To find out the accuracy of the modified triple test in the diagnosis of palpable breast lumps. Materials and Methods: This was a cross-sectional study involving 50 female patients with palpable breast lumps attending the Surgical Out Patient Department of the Regional Institute of Medical Sciences, Imphal between October 2011 and September 2013, who underwent clinical breast examination (CBE), ultrasonography (USG), and fine-needle aspiration cytology (FNAC). All the cases irrespective of results underwent either excisional and or incisional biopsy for confirmation. The final histopathological report was considered the reference standard. Results: A total of 50 patients were included. The age range was 18-56 years. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CBE were 66.6%, 100%, 100%, 90%, and 91.6% respectively; those of USG 91.6%, 100%, 100%, 97.3%, and 97.9% respectively; and those of FNAC 91.6%, 100%, 100%, 97.4%, and 98% respectively. Out of 50 patients, the three tests concurred in 42 (35 benign and 7 malignant) cases. When all the three tests concurred, there were no false positive or false negative cases, and sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were all 100%. Conclusion: The triple test is valid and reliable, with a high degree of accuracy for the diagnosis of breast lumps. Of all the three components of the triple test, FNAC is the most accurate. A patient with a concordant benign triple test report can be safely followed up without the need for biopsy.

Does Final-Needle Aspiration Cytology Of The Braest Is Still An Accurate Diagnostic Technique for Breast Lumps?

Background: Fine-needle aspiration cytology (FNAC) is a simple, accurate, and safe procedure for the diagnosis of palpable breast lumps (PBLs), yet in certain situation there is a need for more definitive and more invasive techniques such as core needle biopsy (CNB) to touch a definitive diagnosis. This procedure is performed instead of excisional or frozen section in some breast cancer units. The aim of this study was to analyze if FNAC is still an accurate procedure for diagnosis of PBLs as well as to correlate between FNAC and histopathological findings of CNB in PBLs. Material and methods: An observational study was conducted on 66 patients presenting with PBLs. All these patients underwent outpatient FNAC. Core needle biopsy (CNB) was performed for the inadequate, suspicious, and malignant cases. Evaluation of all the prepared cytologic and histopathological slides was done. Results: benign tumors are forming the major component of FNAC cases that seen, majority of them is fibroadenoma. Conversely 7 cases are cytologically malignant that proved histologically to be malignant. Three out of 6 cases that are cytologically highly suspicious are diagnosed malignant histologically. Conclusion: in spite of the simplicity, rapidity, and cost effectiveness of FNAC in the preoperative diagnosis of cancer, tissue diagnosis by CNB is highly recommended in selected cases for more confirmation.

Fine-Needle Aspiration Cytology: An Advancing Horizon

The current practice of “Fine Needle Aspiration Cytology (FNAC) has established itself as an important modality in the diagnosis and management of superficial and deep seated lesions throughout the body. With this wide employment of FNAC, the cytopathologists play a pivotal role in the management and therapeutic decisions that are based on the diagnosis of these limited FNAC samples. Furthermore, the use of FNAC samples for biomarker research is advancing rapidly and is being widely investigated and applied for the treatment and prognostic purposes. In this special issue, we have made an attempt to provide a “flavor” of the current practice of FNAC with an emphasis on correlation of tissue biopsies with PET results, FNAC of breast, liver, pulmonary, and head and neck lesions. Similarly, the use of FNAC in the diagnosis of Langerhans cell histiocytosis, neuritic leprosy, and granulomatous inflammation is also discussed. With the increasing use of image-assisted FNAC, pathologists are now an integral part in the diagnosis and management of the deep seated lesions. In lieu of this, it has become important for the pathologists to be aware of the limitations of different imaging techniques. The paper on the correlation of tissue biopsies with PET results discusses the limitations of an increased SUV value on PET scan. The use of fine needle aspiration cytology has been proven to give fast, economical, and valuable diagnosis of palpable breast lumps. In this issue, the role of FNAC in the evaluation of breast lump in a high patient volume center is addressed with emphasis on the importance of skill and training for both pathologists and technicians to prevent suboptimal sampling, thus, increasing the reliability of the procedure. Another important but not commonly discussed aspect of breast FNAC—the nonmalignant categories—is also addressed, with a review of the cytomorphology of benign breast lumps, some of which could be mistaken for malignancy due to the diaphanous appearance and overlapping cytologic features. The false negative and false positive FNAC is further discussed in detail so as to avert misinterpretation. These provide practical information for readers when dealing with FNAC of breast lesions. The paper on liver FNAC covers various aspects and discusses the role of FNAC in liver lesions. There is an active debate about the preoperative/pretransplantation diagnostic role of FNAC of hepatocellular carcinoma (HCC) and precursor lesions, especially in the face of advances in dynamic imaging techniques. New trends in personalized molecular targeted therapy require better characterization and prediction of HCC behavior. FNAC biopsy technique is still the most minimally invasive approach for the procurement of tumor and peritumoral tissue for molecular studies. Thus, in the near future, hepatic FNAC is likely to become a point of care in the management of HCC patients, especially inoperable cases. In the current era of personalized medicine, the FNAC diagnosis of nonsmall cell carcinoma for a pulmonary nodule is no longer considered an adequate diagnosis. Pathologists are often required to further subclassify these in to adenocarcinoma and squamous cell carcinoma. With the increasing use of image-assisted FNAC including endobronchial ultrasound guided FNAC (EBUS-FNA), cytologic or small biopsy material has become the only form of tissue available for diagnosis. The paper on FNAC of pulmonary lesions reviews the current concepts in the suitability and accuracy of FNAC in lung cancers including diagnosis, classification, use of ancillary techniques, and prognostic marker assessment. FNAC is a valuable technique in the workup of nodules and masses arising within the head and neck region. It is primarily utilized to confirm or exclude the diagnosis of malignancy involving head and neck organs especially lymph nodes, thyroid, and salivary glands. It has been shown that FNAC of salivary gland lesions is a valuable way to preoperatively assess lesional tissue, determine the need for surgical intervention, and assist in planning the appropriate surgical approach prior to resection. In this issue, the manuscript on cytologic diagnosis of mucoepidermoid carcinoma discusses the role of FNAC in the diagnosis of mucoepidermoid carcinoma (MEC), the common malignant tumor affecting parotid gland. In addition, it also brings forth how the rare and recently described oncocytic variant can pose problems in the diagnosis of MEC. In conclusion, this special issue includes a potpourri of topics which provides a thoughtful glimpse into various techniques, diagnostic ability, and limitations of the current practice of FNAC. Darshana Jhala Aileen Wee Gary Tse Zubair Baloch

Utility of fine‐needle aspiration as a diagnostic technique in breast lumps

Fine-needle aspiration cytology (FNAC) is a simple, accurate, and safe procedure for the diagnosis of palpable breast lumps. The purpose of this study is to emphasis the utilization of FNAC in the Sudan and to evaluate our experience to identify the types of various breast lesions. A one year descriptive longitudinal study was conducted in Khartoum, Sudan. We obtained information (patient's personal data) and Fine-Needle Aspiration (FNA) samples, for 200 patients with palpable breast lesions. Subsequent tissue biopsies were taken from 131 patients of the 200 studied patients. Data were analyzed using a computer's SPSS program. Pearson chi-square test was used for statistical analyses. The diagnoses of the 200 breast FNAs were as follows: 61 (30.5%) were malignant, 5 (2.5%) were suspicious, and 134 (67%) were benign lesions. Subsequent histopathological examination was performed on 61 (100%) patients with malignant lesions, 5 (100%) of suspicious, and 65 (48.5%) patients of 134 patients with benign lesions. FNAC revealed a 92.6% sensitivity, a 95.2% specificity, a 95.5% positive predictive value, and a 92.2% negative predictive value. Of the 65 benign cases on cytology, five cases were found malignant on histopathology. FNAC of breast lesions is sensitive, specific, and highly accurate as the initial investigation of palpable breast lesions in a population of low resources and without screening program to diagnose breast cancer. We consequently encourage clinicians to embrace this procedure in the management of patients.

Accuracy of Triple Test Score in The Diagnosis of Palpable Breast Lump

Breast lump is a very sensitive issue for the patient so a reliable, non invasive and prompt diagnosis helps to lessen the associated anxiety and leads to early definitive treatment. The aim of this study was to evaluate the accuracy of Triple Test Score (TTS) as a clinical tool for the diagnosis of a palpable breast lump. This diagnostic test study was carried out in the Department of Surgery of Tribhuvan University Teaching Hospital. Of the 117 patients admitted with breast diseases from the breast clinic over thirteen months, 87 had breast lump. Fifty patients underwent Triple Test Score ( physical examination, mammography and fine needle aspiration cytology) and were categorized into benign, suspicious and malignant. This was later correlated with the histopathological findings. Nineteen patients with breast lumps interpreted by TTS as benign correlated with the histopathological findings whereas of 31 malignant lumps, 30 turned out to be malignant and one benign. This gives TTS an over all accuracy of 98% with 100% sensitivity, 95.2% specificity and positive predictive value of 96.7%. Carcinoma was seen in 29 (58%) cases in the age group of 35 to 70 years. The mean age at diagnosis of benign and malignant disease was 41.8 and 45.1 years respectively. In conclusion, TTS is an accurate and least invasive diagnostic test based on which definitive treatment can be initiated.

Fine needle aspiration of palpable breast lumps: a 1-year audit using the Cytospin method.

A fine-needle aspiration (FNA) service for the diagnosis of palpable breast lumps was started at the Royal Preston Hospital, Preston, UK, in November 1989. Over the subsequent year, 407 FNAs were taken from 393 women. A simple technique was used which involved the surgeon flushing the aspirate into 10 ml of Cytospin collection fluid; cytocentrifuge preparations were then safely and conveniently prepared in the laboratory. Slides were stained with Papanicolaou and H&E. The method detected 112 out of a total of 121 cancers (92.6%); of the nine that were undetected, five aspirates were inadequate and four were falsely reported as negative. There were no false positives. The overall inadequate rate was 11.0%. Excluding inadequate samples, the absolute sensitivity was 89.7% and complete sensitivity 96.6% with 94.4% specificity. This 1-year audit has shown the Cytospin method of FNA in palpable breast disease to have a favourable sensitivity and specificity, and therefore to be an alternative to conventional FNA using direct smears.