Breast FNAC Research Articles

FNAC as preoperative diagnostic tool for neoplastic and non-neoplastic breast lesions with special reference to IAC standardised reporting in Coastal population - A teaching hospital experience

Breast cancer is steadily increasing worldwide. This study is based on application of recently proposed International Academy of cytology (IAC) Yokohama categorisation system of Breast cytology from C1 to C5. (C1-Insufficient material, C2-Benign, C3- Atypical, C4-Suspicious & C5-Malignant). We aim to categorize the breast lesions based on the above-mentioned categorization scheme (IAC, Yokohama 2016) along with histopathological correlation (wherever possible). This was a retrospective observational study conducted from January 2018 to December 2021 in the Department of Pathology of a tertiary care hospital involving coastal population. Ethical clearance was taken from institutional reviw committee. All patients with palpable breast lumps who had undergone FNAC were included in the study. Patient details and data were collected from the case records maintained in Department of Pathology. All quantitative parameters were described through descriptive statistics. Total scores were computed for all the risk factors. Sensitivity, specificity, Positive Predictive Value, Negative Predictive Value calculated. Risk of malignancy(ROM) was calculated for each category. A total 200 patients, with age group ranging from 17 - 67 years with breast lesions were included in the study. C1 lesions were found in 5 cases, C2 in 152 cases, C3 in 11 cases, C4 in 4 cases, and C5 in 28 cases. Cytohistological correlation obtained in 94 cases with concordance noted in 89 cases and discordance in 5 cases. Breast FNAC cytology categorization according to IAC Yokohama system increases accuracy of diagnosis and helps clinician in appropriate patient management.

DIAGNOSTIC UTILITY OF BREAST FNAC IN THE EVALUATION OF PALPABLE MASSES - A TERTIARY CENTRE STUDY

Background: The purpose of the study was to evaluate the cytological features of palpable breast masses and to advocate the utility of breast FNAC . Material And Methods: Aretrospective study of one and a half years duration was conducted in the Department of Pathology of a tertiary care hospital which included 110 patients with palpable breast masses. Histopathological correlation in 110 cases was obtained and diagnostic efcacy calculated by sensitivity, specicity, poisitive predictive value (PPV) and negative predictive values (NPV). Results: Cytological diagnosis was rendered in 110 patients with age group ranging from 15 to 68 years. Breast lesions commonly presented in upper inner quadrant (48%) of both breasts. Aspirates were diagnosed as non-neoplastic in 15 lesions (13.6%) and neoplastic in 95 lesions (86.36%) [benign 65.45%, and malignant 20.9%]. There were two false positives and one false negative, with 96.83% specicity, 97.87% sensitivity, PPV 95.83%, NPV 98.39%, and diagnostic efcacy of 97.27% for the palpable breast lesions respectively. Conclusion: FNAC is a rapid and economical procedure with high accuracy for cytological diagnoses of breast masses and helps the surgeon to plan for further treatment.

A Descriptive Study of Reporting of breast Fine Needle Aspirationcytology Using International Academy of Cytology Yokohama System

Background: The International Academy of Cytology (IAC) has established standardizedapproach for reporting breast FNAC by categorizing lesions in a five-tier system from C1 to C5. Materials and Methods: From May 2020 to April 2021, a descriptive cross-sectional study was conducted in the cytology section of the Department of Pathology, SMS Medical College, Jaipur. Results: The current study involved 335 cases of breast FNAC, with a maximum of 333 (99.40%) females and 2 (0.60%) males. Maximum cases were in the age range of 21-40 years. There were 79 (23.60%) cases in C1 (Insufficient) category, C2 (Benign) had 177 (52.80%) cases, C3 (Atypical) had 9 (2.70%) cases, C4 (Suspicious) had 16 (4.80%) cases, and C5 (Malignant) had 54 (16.10%) cases respectively. Fibroadenoma was the most prevalent benign lesion in our analysis, accounting for 45 of the 177 benign cases, whereas ductal carcinoma was the most common malignant lesion.In a total of 92 cases where histology was examined, 86 cases were found to be compatible with the cytological diagnosis. In a triple assessment, 103 (78.03%) of the 132 cases were concordant in the benign group, only 1 (12.50%) case showed concordance in the atypia category, and 21 (39.62%) of the 53 cases showed concordance in the suspicious or malignant category. The Risk Of Malignancy (ROM) was calculated as follows: inadequate 0%, benign 0%, atypia 0%, suspicious for malignancy 71.43%, and malignant 97.56% for each group. Conclusion: This system is a valuable tool for breast cancer patient diagnosis and care. It also simplifies clinical audits and aids in improved coordination between pathologists, hospitals, and institutes.

Diagnostic Accuracy of FNAC for Detection of Malignancy in Palpable Breast Lump and its Comparison with Tru-Cut Biopsy

Breast cancer is the commonest malignancy in women worldwide and leading cause of cancer related deaths in women, almost half of these occurring in developing countries. Aim was to know the diagnostic accuracy of FNAC for detection of malignancy in palpable breast lump and its comparison with tru-cut biopsy Methodology: Six months following the publication of this report, researchers in the Surgical Department of Allied Hospital Faisalabad conducted this study. Starting on March 31st, 2019, and running all the way through September 30th, 2019. Allied Hospital Faisalabad's ethics council approved the study's summary, and patients who presented to the hospital's breast clinic with a palpable breast lump met the criteria for inclusion in the research. Across all patients, histopathology was performed on FNAC, tru-cut, and excisional biopsy specimens. H&E staining was performed on both the tru-cut biopsy and tissue specimens from later excision procedures to examine the histological characteristics of the tumor tissue. Results: In our study, out of 190 cases, frequency of malignancy on was recorded in 28.42%(n=54), the diagnostic accuracy of Tru-cut biopsy for detection of malignancy in patients with palpable breast lump taking histopathology examination after excision biopsy (HPE) as gold standard was recorded as 80.33% sensitivity, 96.12% specificity, 90.74% positive predictive value,91.18% negative predictive value and 91.05% accuracy rate, likelihood ratio was calculated as 20.72 and diagnostic accuracy of FNAC biopsy for detection of malignancy in patients with palpable breast lump taking histopathology examination after excision biopsy (HPE) as gold standard was recorded as 70.49% sensitivity, 93.80% specificity, 84.31% positive predictive value, 87.05% negative predictive value and 86.32% accuracy rate, likelihood ratio was calculated as 11.37. Conclusion: As far as diagnostic accuracy for the diagnosis of malignancy in patients with palpable breast lumps, FNAC and Tru-cut biopsy are both good, although Tru-cut biopsy is more accurate than FNAC in terms of detecting the disease. Keywords: Palpable breast lump, malignancy, diagnosis, FNAC, Tru-cut biopsy, diagnostic accuracy

IAC Yokohama Reporting of Breast Cytology to Assess Risk of Malignancy and Predictive Values

Background: IAC Yokohama system has 5 categories that may be stratified by their risk of malignancy (ROM) and supply guidance within a management algorithm for every category. The main objectives were to categorize 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. Material and Methods: A total of 174 cases were prospectively studied over a period of one year from 1st November 2019 to 31st October 2020 in GMC, Jammu. All the FNAC received was reported routinely according to the newly proposed Yokohama system of reporting breast cytology. The ROM, sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) and accuracy of Breast FNAC were calculated. Results: ROM is 0% for category 1, 2.27% for category 2, 50% for category 3, 50% for category 4 and 100% for category 5. Sensitivity, specificity, and diagnostic accuracy were, respectively, 100%, 100% and 99.11% for category A (only C5 category cases considered positive test results), 88.2%, 93.6%, and 93.6% for category B, (both C4 and C5 categories considered positive test results), and 94.1%, 91.48%, and 92.1% for category C (C3, C4, and C5 category cases grouped as positive test results). PPV and NPV were also calculated. Conclusion: Categorization of the Breast FNAB cytology according to IAC Yokohama system of reporting helps pathologist in the diagnostic clarity and guides clinician in the appropriate patient management.

Microfilaria detected in a female breast nodule- A rare incidental finding in FNAC

Microfilaria is a major public health problem in tropical countries like India. It is most commonly diagnosed in peripheral blood smears, but detection of microfilaria in FNAC of breast is a rare finding. We are reporting a case of 35 year old female who presented with a painless nodule in left breast. Fine-needle aspiration cytology from the nodule was done, aspiration showed many sheathed motile microfilaria likely Wuchereria bancrofti and the patient was put on anti-filarial treatment with Diethyl carbamazine citrate. In endemic areas, it should be considered as one of the differential diagnoses of a superficial swelling. Despite its high prevalence, filariasis in female breast is a rare finding and careful screening of nodules help in detecting microfilaria even in asymptomatic patients and thus plays a significant role in recognition of the disease and institution of specific treatment.

To assess the feasibility and diagnostic accuracy of preoperative ultrasound and ultrasound-guided fine needle aspiration cytology of axillary lymph nodes in patients of breast carcinoma.

Background:Metastasis of the lymph node is one of the most significant prognostic factors for breast cancer (BC).Aim:To predict positivity of the lymph node in BC patients with help of USG and USG-guided FNAC and thus to prevent unnecessary morbidity.Methods:50 patients of incisional/true cut biopsy-proven BC patients were included. All were subjected to mammography, USG and FNAC of the lump breast. USG-guided FNAC of the axillary lymph node was done in 25 of these patients. These findings were assessed by histological examination following dissection of the axillary lymph node.Results:Axillary lymph node (ALN) metastasis was present in 42 patients on histopathology; 21 patients suspicious of malignancy on preoperative USG were confirmed by HPE. Out of 88 confirmed lymph nodes evaluated on ultrasonography, 4 were benign, 18 were indeterminate and 66 were suspicious. The most promising features were tumour length/depth ratio of <1.5 in 81, absent fatty hilum in 73% and hypoechoic cortex in 74%. Assessment of axilla with USG had a sensitivity of 50%, a specificity of 100%, a PPV of 100%, an NPV of 27.59% and a diagnostic accuracy of 58%. Preoperative USG-guided FNAC had a sensitivity of 91.67%, a specificity of 100%, a PPV of 100%, an NPV of 33.33% and a diagnostic accuracy of 92%.Conclusion:USG can detect non-palpable axillary lymph nodes and FNAC can increase the sensitivity and specificity of this technique, which makes this procedure very promising in detecting axillary metastases in BC patients.

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.

INCIDENCE OF BREAST CARCINOMA IN PREGNANT AND LACTATING WOMEN

INTRODUCTION: Breast lumps are a common problem encountered in pregnancy and lactation. These lumps are generally benign like broadenoma, lactating adenoma, mastitis and galactocele. Although rare the possibility of breast cancer (Pregnancy Associated Breast Cancer) should be considered, which is increasing in incidence nowadays. MATERIAL AND METHOD: A prospective study for 18 months was conducted on pregnant and lactating females for evaluating the role of cytology in interpretation of breast cancers. Clinical details, imaging ndings and histopathological correlation (wherever available) was also analyzed. RESULT: 85 breast lumps were identied and benign lesions were the most common etiology seen. Three cases were identied as pregnancy associated breast carcinoma (PABC) constituting 3.5% of all breast lumps. CONCLUSION: Cytology was an effective tool with minimal surgical intervention in identifying the etiology of breast masses in pregnancy and lactation. However, the cytopathologists must be aware of the characteristic patterns seen in breast FNAC smears during pregnancy and lactation and the associated atypia seen in glandular epithelium during this period. Breast carcinoma is the most common malignancy associated with pregnancy. The incidence is low but increasing due to late childbirth. Breast cancer during pregnancy has a similar prognosis to that of breast cancer in young.

RETROSPECTIVE CYTOLOGICAL STUDY OF FIBROADENOMA CASES IN A TERTIARY CARE HOSPITAL CHANDRAPUR

Background: Fibroadenomas are the most common benign breast diseases in country. Aim of study is to determine some demographic factors &amp; the clinical summary of fibroadenoma cases in our tertiary care hospital. Material&amp;Methods: A retrospective cytological study of fibroadenoma for period of 2years from medical records of January2017 to December2018. Results: All 142 cases were females. Most common age group was 21 to 30 years (50%) followed by 31 to 40 years (38%). Right breast was commonly involved and most fibroadenomas were confined to upper and outer quadrant. Conclusion: .FNAC of breast is economic, safe, and highly accurate method for diagnosis of breast lump preoperatively to avoid undue surgery and inconvenience during biopsy. Health education, Breast self-examination and FNAC is recommended for early diagnosis and management

FNAC of breast: An institutional experience

Introduction: Fine needle aspiration cytology is fast becoming preoperative method of choice for diagnosis and management of various breast lesions since few decades. It is one of the component of triple test done for preoperative diagnosis of breast lump along with clinical examination and mammography. It helps clinician to decide mode of treatment in most cases in both non-neoplastic and neoplastic disorders. The aim of our study was to assess utility of FNAC in the diagnosis and management of breast lesions, age and sex distribution of these lesions and to find out the various cytomorphological patterns of breast lumps. Materials and Methods: The present study was done during the period between December 2015 and March 2018 in the department of pathology (central clinical laboratory), Koppal Institute of medical sciences, Koppal. 10ml syringe and 23/24 gauge needles were used for the procedure. Material obtained was expressed on slide and smears were made by standard smearing technique. Both wet and air dried smears were made. Wet smears were stained with Haematoxylin and Eosin stain and dry smears with Lieshman stain and Giemsa stain. Results: We assessed 103 cases with 106 lesions of breast. We got satisfactory aspirate in most cases. Fibroadenoma (49%) was the most common lesion. Metastatic carcinomas were common after 30yrs age group. Conclusion: Fine needle aspiration is simple, rapid and cost effective method for preoperative assessment of breast lumps. Fibroadenoma is the most common breast lesion and most common tumor. It significantly reduced unnecessary surgical biopsy for diagnosis of breast lump in our study. Keywords: FNAC, Breast.

Frequency of benign breast diseases in female patients presenting with breast lumps - a study at Sir Ganga Ram Hospital, Lahore

Objective: To determine the frequency of benign breast diseases in female patients in our setup. Design: Prospective descriptive study. Place and duration of study: The study was carried on female patients presenting at surgical out door of Sir Ganga Ram Hospital, Lahore during one year i.e. January 2001 to January 2002. Patients and methods: Two hundred female patients presenting with breast lumps at surgical out door of Sir Ganga Ram Hospital, Lahore during one year were studied. All the patients were examined clinically with special emphasis on breast, axilla and supra clavicular fossae. Basic laboratory investigations including blood complete examination, urine complete examination and chest X -ray were done for all the patients. Breast imaging and FNAC of lumps were also done. Final diagnosis was based upon histological examination of the tissues biopsied from the lump. After collecting data, written in proforma, window SPSS software was used to analyze the results. Results: This study shows a high f requency of fibroadenoma (45%) in Pakistani females. Fibrocystic disease is second in frequency and accounts for 36% patients.8% patients had intraductal papilloma and three percent suffered from duct ectasia.5% patients had other conditions related to breast including two patients presenting with pre histological diagnosis of fibrocystic disease who turned out to be malignant after histopathology. Most of the patients had age range of 20-29 years. Conclusion: Fibroadenoma is the commonest of all benign breast diseases in Pakistani women. Fibrocystic change is the second in this regard. Benign lesions of the breast can resemble its carcinoma on clinical examination.

Cytolo-histological correlation of breast lump-as a part of internal quality control

Introduction: Fine Needle Aspiration Cytology (FNAC) has gained increasing importance in the diagnosis of breast lumps especially it is an easy, non-invasive, simple procedure which can be done on OPD basis. The pre–operative diagnosis of breast lesions by FNAC is highly relied upon. However, there can be some cytological pitfalls in the diagnosis, especially when all the characteristic component of a lesion are not obtained in the aspirate, or when there is an overlap in the cytological features. Hence a review was undertaken with the following objectives. 1. To correlate cytologic and histopathologic diagnosis of breast lesions as a part of internal quality control. 2. To know the incidence of false positive and false negative cases. 3. To find out the sensitivity and specificity of FNACof breast lesions. Methods: This study was conducted for a period of 3 years (April 2009 to March 2012) and 200 cases of fine needle aspirates of breast lumps studied. Out of which 126 cases were followed by histopathological correlation at pathology department; the cases are collected from Mahatma Gandhi Medical College & Research Institute, Sri Balaji Vidhyapeeth University; Pondicherry. Results: Out of 200 cases studied by FNAC, histopathological correlation was available for 126 cases. Cytological diagnosis in general was divided into four categories, benign (76.19%), malignant (15.08%), suspicious (5.56%), and unsatisfactory (3.17%). Maximum patients were in age group of 21 to 30 years. There were 119 female patients and 7 male patients. Fibroadenoma (69.79%) was most common benign neoplasm. There were 5 cases (5.21%) reported by FNAC as gynecomastia. After correlation with histopathology, there was 82.26% of correct diagnosis in all benign lesions. There were 16 cases (84.21%) diagnosed cytologically as malignant and 3 cases (15.79%) as invasive duct carcinoma. Histopathologically all were confirmed as invasive duct carcinoma. Out of that one was reported in male breast. The incidence of false positive case was zero, false negative case was (1.59%). The diagnostic accuracy after histopathological correlation in malignant cases was 98.36%, sensitivity was 92.86% and specificity was 100%. Conclusion: To conclude, fine needle aspiration cytology is a fairly safe procedure in trained hands, and it gives reasonably accurate results, thereby helping the clinicians to plan the best line of treatment. Also with invention of imaging guided aspiration, FNAC went one step ahead in diagnosis of non-palpable lesion of breast. Thus a triple modality of clinical, mammographic and cytological correlation is required and for internal quality control FNAC is correlated with histopathology. Key Words: FNAC; Breast lumps; Breast neoplasm

Triple test in carcinoma breast.

The commonest clinical presentation in majority of breast pathology is a lump. A definite diagnosis of breast lump is very important for the surgeon to decide on the final course of treatment and also saves the patient from unnecessary physical, emotional and psychological trauma if there is a definite preoperative diagnosis of benign lesion. The present study was done to evaluate the effectiveness and relevance of "TRIPLE TEST"in diagnosis of carcinoma breast in rural labour class population. The present study was a prospective study conducted on patients over 35 years of age having palpable breast lumps presenting in the out patient department of general surgery, ESI Hospital Basaidarapur New Delhi, India. The duration of study was from May 2007 to June 2009 and a total of 100 cases were studied. Each patient was subjected to a detailed history, clinical breast examination ,diagnostic mammography and FNAC. In this study, the results of each modality was divided in three groups: benign, suspicious and malignant. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of each test was calculated individually and as combined. Out of 100 patients enrolled in this study, 60 cases were benign and 40 cases were of malignant breast disease. The age of patients with carcinoma breast in the series varied from 35 years to 70 years. The highest incidence of malignancy noted was 30% in 41-50 years age group (4(th) decade) followed by 27.5% in 51-60 years age group (5(th) decade). The sensitivity of clinical examination was found to be 75%, specificity was 83.3%, positive predictive value (PPV) of 75% and diagnostic accuracy of 80%. The sensitivity, specificity, positive predictive value and diagnostic accuracy of mammography was calculated and was found to be 94.9% , 90% , 86% and 92% respectively. The sensitivity, specificity, positive predictive value and diagnostic accuracy of FNAC was 94.7%, 98.3%, 97.3% and 96.6% respectively. Out of 100 cases triple test was concordant (all three test either benign or malignant) in 80 cases, all the benign cases detected by triple test were benign on final biopsy i.e. 100% specificity and 100% negative predictive value. TTS is an accurate and least invasive diagnostic test based on which definitive treatment can be initiated.

Analysis of metaplastic breast carcinoma: FNAC; histopathology and immunohistochemistry are complementary for diagnosis

Metaplastic breast carcinoma (MBC) is a rare malignancy comprised of ductal, squamous and/or mesenchymal elements with problematic diagnosis. This study analyses MBC identifying its cytologic and histologic features and emphasizing the combined role of FNAC, histopathology and immunohistochemistry (IHC) in its diagnosis. Cytology and histopathology files search yielded 21 cases identified as MBC from January 2005 to December 2010. FNAC and the histopathology slides were re-examined for the presence and frequency of various elements. Cytological and histopathological diagnoses were made and the cases subtyped according to WHO classification. Cytokeratin and vimenten IHC were used to confirm diagnosis when required. On FNAC, 52.4% were diagnosed as malignant, 9.5% as suspicious for malignancy and 38.1% as benign lesions. Most frequent cytologic findings were squamous and spindle cell elements (52.4% each). Histopathology revealed 76.2% pure epithelial tumors and 23.8% mixed epithelial-mesenchymal tumors. Squamous cell carcinoma was the most frequent histological subtype (33.3%). Carcinosarcomas were dimorphic on IHC& spindle cell carcinomas were positive for both cytokeratin and vimentin. Presence of dual components, squamous, spindle elements, mesenchymal fragments and necrosis in moderate to high cellularity breast FNAC provides clues for the diagnosis of MBC. FNAC; histopathology and IHC complement for diagnosis.

The role of breast FNAC in diagnosis and clinical management: a survey of current practice

The role of breast FNAC in diagnosis and clinical management: a survey of current practice

The role of breast FNAC in diagnosis and clinical management: a survey of current practice

Most participating countries have now adopted a triple assessment approach, i.e. clinical,imaging and pathology, to breast diagnosis, with FNAC as the first-line pathological investigation in both screening and symptomatic populations, with the exception of microcalcifications. Pathologists specialized in cytopathology are best qualified to collect and interpret FNAC samples, but this is not always possible or practical. Radiologists involved in breast imaging should ensure that they have the necessary skills to carry out FNAC under all forms of image guidance. Best results are achieved by a combination of both techniques, as shown in the image-guided FNAC in the presence of the cytopathologist. The majority of European countries use similar reporting systems for breast FNAC (C1-C5), in keeping with European Guidelines for Quality Assurance in Breast Cancer Screening and Diagnosis, although some still prefer descriptive reporting only. When triple assessment is concordant, final treatment may proceed on the basis of FNAC, without a tissue biopsy. ER and PR assessment can be done safely on FNAC material. However, not all institutions may have expertise in doing this. HER-2 protein expression on direct cytological preparations is insufficiently reliable for clinical use, although its use for FISH is possible, if expertise is available. The majority of participants practise a degree of one-stop diagnosis with a cytopathologist present in the out-patient clinic. Formal recognition of the importance of the time spent outside the laboratory, both for cytopathologist and cytotechnologist, is necessary in order to ensure appropriate resourcing. The use of core biopsy (CB) has increased, although not always for evidence-based reasons. CB and FNAC are not mutually exclusive. FNAC should be used in diagnosis of benign, symptomatic lesions and CB in microcalcifications, suspicious FNAC findings and malignancies where radiology cannot guarantee stromal invasion.

Proceedings of symposium on "FNAC of Breast"

Proceedings of symposium on "FNAC of Breast"

0-98. The effect of needle size and local anaesthetic on the pain and diagnostic accuracy of breast FNAC

0-98. The effect of needle size and local anaesthetic on the pain and diagnostic accuracy of breast FNAC