Fine Needle Aspiration Cytology Of Breast Lesions Research Articles

Significance of Plasma Thromboplastin Cell Block Technique as an Adjunct to Fine Needle Aspiration Cytology in Diagnosis of Breast Lesions

Introduction: Despite the fact that Fine Needle Aspiration Cytology (FNAC) has been widely utilised in the preoperative diagnosis of breast lumps, the Conventional Smears (CS) have drawbacks, including difficulty in understanding the pattern or architecture of the lesion, determining invasiveness, Immunohistochemistry (IHC), false positives, and false negatives. Cytologists advise using Cell Blocks (CB) to increase the diagnostic precision of FNAC. In this study, the significance of using Plasma Thromboplastin Cell Block (PTCB) routinely as an addition to CS in FNAC of palpable breast lesions. Aim: To determine the significance of PTCB as an adjunct in addition to CS to diagnose breast lesions. Materials and Methods: The present prospective observational study was conducted in the Department of Pathology, Chettinad Hospital and Research Institute, Kelambakkam, Chennai, Tamil Nadu, India, between July 2021 and June 2022 on 30 samples of palpable breast lesions. From the fine needle aspirates, smears were prepared and stained with Leishman and Papanicolaou stains. The residual material in the hub was rinsed in saline. The plasma-thromboplastin method was used to prepare CB, and Haematoxylin and Eosin (H&E) sections were made. A point scoring system was used and findings were compared to histopathology. IHC markers namely Estrogen Receptor (ER), Progesterone Receptor (PR), Human Epidermal Growth Factor Receptor-2 (HER2), Proliferation marker Ki-67 was utilised wherever appropriate. The results were analysed using Statistical Package for the Social Sciences (SPSS) software version 21.0. Results: Out of total 30 subjects, majority (n=9, 30%) were in the age group of 41-50 years. The mean scores of CS {background (0.93±0.25), cellularity (1.7±0.55), morphology (1.7±0.47) and architecture (1.03±0.32)} and PTCB {background (1.77±0.43), cellularity (1.77±0.48), morphology (1.8±0.48) and architecture (1.5±0.57)} were compared using the point scoring system. Though the mean scores of all four parameters were higher in PTCB than in CS, the statistically significant difference was seen in background (p-value=0.001) and architecture categories (p-value=0.0001). The PTCB finding as a screening test for predicting histopathological diagnosis showed a sensitivity of 94.44%, specificity of 100%, Positive Predictive Value (PPV) of 100%, Negative Predictive Value (NPV) of 92.3%, and 96.67% accuracy. IHC staining was feasible in CB and findings were comparable to biopsy. Conclusion: The routine use of PTCB technique in FNAC of breast lesions, along with smears, will aid in IHC, reducing diagnostic pitfalls, thereby reducing misdiagnosis and invasive procedures, particularly in suspicious for malignancy cases, which can lead to inappropriate radical treatment causing physical and psychological stress to patients.

Reproducibility of the "International Academy of Cytology Yokohama System for Reporting Breast Cytology" - A Retrospective Analysis of 70 Cases.

Fine-needle aspiration cytology (FNAC) is the most practiced initial method for evaluation of breast lesions. The International Academy of Cytology Yokohama System for Reporting Breast (IAC YSRB) Fine-Needle Aspiration Biopsy Cytopathology has been developed to standardize the reporting system. However, literature available on the inter-observer reproducibility of 5 IAC YSRB categories is limited. We investigated the inter-observer reproducibility of the IAC YSRB system. A total of 70 consecutive specimens obtained from FNAC of breast lesions were reviewed retrospectively by 3 experienced cytopathologists who allotted 1 to 5 IAC YSRB categories. The percent overall agreement between observers was 70.48% and the free marginal kappa was 0.63, which signifies substantial agreement. After combining "Suspicious" and "Malignant" categories, overall agreement was 80.95% and free marginal kappa became 0.75. Inter-observer agreement of three (70.48%) cytopathologists was substantial. Agreement can be improved by combining certain categories, especially "Suspicious" and "Malignant". Technical quality limitation plays a significant role in a proportion of cases, mainly the "Atypical" and "Suspicious of malignancy" categories. Application of the IAC YSRB system in day-to-day practice will increase the inter-observer agreement.

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.

Cytological Study of Breast Lesions with Histopathological Correlation

Introduction: Breast disease is the most common and ranks first among malignant tumors affecting females in many parts of the world. Timely and accurate diagnosis of a breast lump is lifesaving. Fine-needle aspiration cytology (FNAC) is a simple, safe, inexpensive method with wide acceptance and used as a first-line diagnostic procedure for diagnosis of breast lesions. Aim: The aim of the study was to diagnose any palpable lump of the breast in females by cytology and correlate with histopathology wherever possible. Setting and Design: This was a retrospective and prospective descriptive study carried out in the pathology department at our institute. Materials and Methods: This study was done for 2 years. FNAC of breast lesions was done, processed routinely, and stained with Papanicolaou stain. Histopathological correlation was done wherever possible on Tru-cut biopsies, excisional biopsies, and surgical specimens received. Statistical Analysis: The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated. Results: Among 304 cases, 229 were benign and 75 were malignant on cytology. Out of this, 79 cases underwent histopathological examination, in which 32 were benign and 47 were malignant cases. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the present study were 79.16%, 96.77%, 97.73%, 75%, and 86.08% respectively. Conclusion: The FNAC is an important preliminary diagnostic test in palpable breast lumps and the results show a high degree of correlation with a final histopathological report.

FNAC of Breast Lesions with Special Reference to IAC Standardized Reporting and Comparative Study of Cytohistological Grading of Breast Carcinoma.

Background:International Academy of Cytology (IAC) has established a process to produce comprehensive and standardized approach to fine-needle aspiration cytology (FNAC) reporting. They have categorized the breast lesions in C1 to C5. (C1-Insufficient material, C2-Benign, C3- Atypical, C4-Suspicious & C5-Malignant).Aims and Objectives:The aim of study is to classify various breast lesions (C1 to C5) and to grade breast carcinoma on FNAC using Robinson's grading system which is then correlated with modified Bloom–Richardson grading.Materials and Methods:All routine FNAC for breast lump were included in the study during the period from Jan 2016 to Jan 2017. The study was conducted in the Department of pathology and lab medicine of a tertiary care hospital in central India.Results:A total 225 female patients were included in the study, with an age group ranging from 15 - 79 years, with lesions in breast were taken. C1 lesions were found in 3 cases, C2 in 186 cases, C3 in 13 cases, C4 in 4 cases, and C5 in 19 cases. Correlation of cytohistological grading was obtained in 108 cases.Conclusion:Cytological categorization based on IAC structured reporting will enhance the reproducibility of reports among pathologist & clinicians. With the comparison between cytohistological nuclear grading, the cytoprognostic scores will help in evaluating the aggressiveness of tumor, predicts histological grade and prognosis. It could be a useful parameter for selecting neo-adjuvant chemotherapy.

Cyto-Histopathological Correlation of Breast Lump as a Part of Internal Quality Control

Background: Breast malignancy is the most widely recognized tumor in females around the world. With the advent of fine needle aspiration cytology (FNAC), the approach to diagnosis and management of breast lesions has been revolutionized. Its accuracy in many situations can approach that of histopathology in providing an unequivocal diagnosis. Hence a review was undertaken with the following objectives. To correlate cytological and histopathological diagnosis of breast lesions as a part of internal quality control. To know the incidence of false positive and false negative cases. To find out the sensitivity and specificity of FNAC of breast lesions. Methods: This study was conducted for a period of 2 year and 102 aspirations of breast lumps studied. Out of which 82 cases were followed- up by histopathological correlation. Results: Cytological diagnosis in general was divided into four categories, benign (76.29%), malignant (18.29%), suspicious (2.44%), and unsatisfactory (00). Age of the patient was range from 16 - 62 years with mean age of 32 years. There were 76 female patients and 06 male patients. Fibroadenoma (54.87%) was most common benign neoplasm. The two cases which were categorized as “Epithelial Hyperplasia, Suspicious” by cytology turned out to be malignant lesions on histopathology. Sensitivity and specificity of FNAC in breast lesions were reported to be 88.24 % and 100% respectively, with 100% positive predictive value and 97.01% negative predictive value. Conclusion: Considering the high specificity and sensitivity of aspiration cytology in the cases of breast lesion, it can be established as an internal quality control at tertiary centre to minimize economical stress demanded for EQAS (External Quality Assessment Scheme).

To Evaluate the Applicability of Parameters of Cytological Grading Systems on Aspirates of Breast Carcinoma.

Background:Fine-needle aspiration cytology (FNAC) is still an important first line diagnostic procedure in developing countries. FNAC of breast lesions is quite specific and sensitive investigation and the results are comparable to histopathology.Aim:To evaluate applicability of parameters of different cytological grading (CG) systems, for aspirates of breast cancers, and its correlation with histopathology grading parameters.Materials and Methods:A cross-sectional observational study was carried out on 30 female patients with ductal carcinoma breast, diagnosed on FNAC and subsequently confirmed histopathologically. The cytological smears were graded using six different cytological parameters/criteria described by Robinson et al. (Robinson grading system) and modified Scarff-Bloom-Richardson (SBR) grading system considering three parameters. The results of cytological grade (CG) were compared with parameters of gold standard modified SBR histological grading (HG) system.Results:Important influential cytological parameters to predict final RBS cytological score came out to be chromatin, nucleoli, nuclear size, cell uniformity, and cell dissociation with statistically significant P value (0.0001) except for mitotic count. The important influential predictor of final SBR histological score is nuclear pleomorphism.Conclusion:SBR HG has good correlation with both RBS and SBR CG systems. The cytological nuclear grade provides important prognostic information which is very sensitive and equally specific hence should be done in breast aspirates and is now replaced by Core Needle biopsy. In developing country like India FNAC of breast aspirates still holds diagnostic value in the classification of breast lesions as compared to core guided image biopsy.

Accuracy of fine-needle aspiration cytology in the diagnosis of breast cancer a single-center retrospective study from Turkey with cytohistological correlation in 733 cases.

The triple test, i.e., cytology combined with clinical and radiological findings, is the goal for accurate assessment of palpable breast lesions. Because of the limitations of fine-needle aspiration cytology (FNAC), its utility has somewhat decreased nationwide. We have been using a combination of physical examination, radiological modalities, and FNAC for the diagnosis of palpable/nonpalpable breast mass lesions for the last 23 years. Our institutional experience of the last 10 years is presented here, using FNAC of breast lesions along with an analysis of the diagnostic accuracy. 4956 breast aspirates in 4860 cases were collected from the computer database of Haydarpasa Numune Education and Research Hospital in Istanbul, Turkey. Most of the FNACs were performed under ultrasound guidance and FNAC procedures were performed by radiologists and pathologists who used 22 gauge needles. Cytological diagnoses were classified as "unsatisfactory", "benign", "malignant", "atypical/probably benign", "atypical/probably malignant", and "atypical/NOS" (not otherwise specified) and were compared to the histopathological diagnoses obtained from core needle biopsy, lumpectomy or mastectomy to give an assessment of the diagnostic performance of FNAC in 733 aspirates. The sensitivity, specificity, accuracy, positive and negative predictive value, false positive, and false negative rates of FNAC were 98.02, 90.58, 95.97, 96.48, 94.54, 2.6, and 1.4%, respectively. This study once again shows that FNAC is a reliable method for the initial evaluation and diagnosis of breast masses. In case of any suspicious conditions, FNAC, and core biopsy are considered complementary to one another.

Cytological study of palpable breast lumps (407 cases) with their histological correlation

Background: In India a large number of patients have been suffering from breast cancer and with each passing year, the number is increasing. Fine needle aspiration cytology (FNAC) is an inexpensive, simple and highly accurate means of diagnosing both benign and malignant breast lesions. The procedure provides a rapid and non-morbid diagnosis before the operation which enables the patient and the surgeon to discuss and plan therapeutic alternatives in a rational atmosphere. Aims & Objective: To find out the common causes of breast lesions, to evaluate role of FNAC in the diagnosis of them, their risk categorization for development of cancer and to conduct cytohistological correlation wherever possible. In addition the sensitivity, specificity, positive & negative predictive value of FNAC in breast lesions are carried out. Material and Methods: The present study was carried out on 407 patients who presented with palpable lump in the breast in the Department of Pathology, Government Medical College, Ahmedabad over a period of one year. FNAC slides were examined under light microscope after H&E, Papanicolaou & May-Grunwald –Giemsa staining and were categorized as Unsatisfactory sample, inflammatory, Benign, Atypical probably benign, suspicious probably malignant and Malignant. Cytological Diagnosis was correlated with histological findings wherever possible. Results: Cytologically, the lesions were categorized in, Unsatisfactory 28 (6.87%), inflammatory 64 (15.72%), Benign 229 (56.26%), Atypical probably benign 8 (1.96%), suspicious probably malignant 8 (1.96%) and Malignant 70 (17.19%). Out of these 407 cases, 161 cases (39.55%) were available for histopathological examination. The most common benign lesion in this study was fibroadenoma 178/229 (77.72%) and the most common malignant lesion was infiltrating ductal carcinoma 51/70 (72.85%). The sensitivity and specificity of FNAC came out to be 98.08%, 98.86% respectively& positive & negative predictive value of FNAC were 99.35% &96.66% respectively. Conclusion: The FNAC of breast is cheap, safe and highly accurate preoperative method for diagnosis of breast lesions. Preoperative categorization of breast lesions is utmost important for management of the patient.

Utility of Fine Needle Aspiration Cytology in the Evaluation of Breast Lesions

Fine Needle Aspiration Cytology (FNAC) is a simple, minimally invasive, cost effective, outpatient based and a rapid diagnostic method for breast lesions. The aim of the present study was to correlate cytological findings with histopathological findings and to determine the accuracy of FNAC in the diagnosis of breast lesions. A total of 222 breast aspirates were studied. Histo-cytopathological correlations were obtained in 91 cases. All the aspirates were stained with Haematoxylin and Eosin (H andE) stain. Among 222 patients, 217 were females and 5 were males. Benign breast lesions were found in 144 cases (64.87%); among which fibroadenoma (30.18%) was the commonest lesion which was observed. Malignancy was observed in 69 cases (31.08%); among them, ductal carcinoma was the predominant lesion (29.28%) which was seen. Histopathological confirmations were obtained in 90 cases out of 91 cases in which histo-cytopathological corrections were possible. All 45 malignant aspirates were confirmed by histopathology. Benign reports were confirmed in 45 out of 46 cases by doing histological examinations; except one case which was diagnosed as malignant by studying its histopathology. Sensitivity and specificity of FNAC in breast lesions were reported to be 97.82% and 100% respectively, with 100% positive predictive value and 97.85% negative predictive value. Diagnostic accuracy of FNAC in the present study was found to be 98.90%. It is important to remember that a negative FNAC of a breast lesion does not preclude the diagnosis of a carcinoma, particularly in presence of a clinical suspicion of malignancy and/or an abnormal mammogram.

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

The value of systematic pattern analysis in FNAC of breast lesions: 225 cases with cytohistological correlation

Background:Fine needle aspiration cytology (FNAC) has a high rating in the assessment of breast lesions. Various methods have been used to diagnose cytology of breast lesions.Aims:Present study was undertaken to evaluate the feasibility of application of systematic pattern analysis based on morphology in diagnosing breast aspirates.Materials and Methods:This is a retrospective study of FNAC of the breast done over a period of 4 years in a tertiary care centre. A total of 225 cases of breast lesions for which FNAC was done with histological follow-up were included in the study. Breast aspirates were provisionally diagnosed based on systematic pattern analysis. Aspirates were grouped into six categories based on predominant cellular pattern, and correlation between cytological and histological diagnosis was assessed.Results:Application of pattern analysis on FNAC of breast lesions in our study had a sensitivity of 94.5%, specificity of 98%, diagnostic accuracy of 97%, positive predictive value of 95.8%, and negative predictive value of 97.4%.Conclusions:Systematic pattern analysis based on morphology of FNAC smears was found to be highly reliable and could be easily reproducible in the assessment of breast masses.

Abstract P6-01-05: Long-Term Diagnostic Accuracy of Fine-Needle Aspiration Cytology Performed in a One Stop Clinic for the Diagnosis of Suspect Nodular Breast Lesions

Abstract Background: Fine-needle aspiration cytology (FNAC) has been used extensively in the diagnosis of breast lesions, but false-negative rates are a matter of concern. Immediate onsite evaluation of breast lesions, combining FNAC results with clinical and radiological data allows improving its diagnostic accuracy. The objective of this study was to evaluate the diagnostic accuracy of a large series of FNAC of breast lesions during the first 3-year period of a dedicated one-stop clinic, by comparing the FNAC results with the corresponding definitive histological examination outcome or the results of the radiological follow-up at 18 months. Method: Data of all consecutive patients (pts) whose lesions were prospectively characterized by ultrasonography (US) and diagnosed by FNAC in the one stop clinic of the Institute Gustave Roussy between May 2004 and March 2007. Histological verification by core-needle biopsy or surgery was systematically performed for lesions classified malignant or suspicious by cytopathology, and for benign lesions, when no perfect concordance between clinico-radiologic features and FNAC results (such as benign FNAC but BI-RAD 5) was found. For non-operated patients, follow-up consisted on biannual US and/or mammography; the results at 18 months were considered. Pts characteristics, radiological findings, cytopathological and histological results were extracted from the hospital computerized prospectively registered medical records. Complete sensitivity (number of carcinomas that were malignant or suspicious by cytopathology) and full specificity (benign lesions at cytology of the total number of benign lesions) were calculated by comparing the cytopathological results to the histological or the long-term follow-up status. Results: A total of 1822 nodular breast lesions (mean size: 20 mm, BI-RAD ACR 1/2/3/4/5/unknown: 10/96/471/459/777/9) in 1739 pts (mean age: 56 years) were studied. FNAC was US-guided in 1115 lesions (61 %). Lesions were classified by FNAC as malignant in 842 (46%), benign in 771 (42%), suspicious in 154 (9%), and unsatisfactory in 55 (3%) cases. Complete sensitivity (number of carcinomas that were malignant or suspicious by cytopathology) was estimated at 98.5%, whereas full specificity (benign lesions at cytology of the total number of benign lesions) was equal to 94.4%. There were 4 false-positive lesions and 32 false-negative lesions, but all these lesions except one were operated as radiological results were suspicious of malignity. Conclusions: Breast FNAC performed in a dedicated one-stop clinic with immediate on-site diagnosis presented a low rate of unsatisfactory specimens and a very efficient tool for triaging patients candidates for histological evaluation conversely for follow-up by imaging. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P6-01-05.

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.

Fine needle aspiration cytology of palpable breast lesions. Histologic subtype in false negative cases.

To evaluate the use of fine needle aspiration cytology (FNAC) in the management of benign and malignant breast disease in an outpatient breast clinic and to determine the guidelines for reporting on FNAC of breast lesions, we evaluated the test results in correlation with the histologic diagnosis. We evaluate the test results of 669 cases of FNAC of the breast in 17 months in our outpatient breast clinic in correlation with the histologic diagnosis, histologic subtype according to the Japan Mammary Cancer Society classification and mammography results in false negative cases. Among 669 cases, 25.3% were inadequate for cytologic diagnosis. An analysis of the results using the two-by-four contingency table, including cases with inadequate cytologic diagnosis, showed that 10.6% and 1.0% had false negative and false positive cytologic diagnoses, respectively; sensitivity and specificity were 76.9% and 91.6%, respectively. The false negative rate of 10.6% was higher than expected, and those belonged mostly to the "inadequate" cytologic diagnosis category even though they were discrete, obviously malignant masses clinically. To try to explain this, we compared the cytologic results and histologic subtype according to the Japan Mammary Cancer Society classification and the mammography results. Of 73 cases of infiltrating ductal carcinoma in which retrospective reexamination of the histology slide was possible, 27 (37.0%) were papillo-tubular type, 11 (15.1%) were solid-tubular type and 35 cases (47.9%) were scirrhous type. Although the scirrhous subtype was only 37.0% in the group in which a cytologic diagnosis of carcinoma was possible, more than two-thirds of the cases of false negative cytology were scirrhous type and had malignant mammographic findings. This finding was statistically significant. In cases of ductal carcinoma of scirrhous subtype, the FNAC tended to be inadequate and false negative, but mammography showed better discrimination in such cases.