Palpable Breast Lesions Research Articles

Cytological Evaluation of Palpable Non-Neoplastic Breast Lesions among Women attended from Rural Community of Bangladesh: A Retrospective Cross-Sectional Study

Background: Non-neoplastic palpable breast disease is one of the most common disorders from which women suffer throughout the world. The use of fine-needle aspiration cytology (FNAC) method has proven to be quick, simple and cost-effective with minimum risk of complications in the evaluation of breast lumps. Objective: This study was planned to find out the common causes of various types of non-neoplastic breast lesions of female at different ages through fine needle aspiration cytology. Methodology: The retrospective cross-sectional study was carried out in the Department of Pathology at Monno Medical College& Hospital, Manikganj, Bangladesh. It lasted 2 years 6 months from July 1, 2019 to December 31, 2021. This study examined all breast lumps found in female patients. For data analysis, the patient's age and FNAC report were recorded. Aspirates were done using 5ml/10ml syringe and 23-gauge needle. Smears were stained with Papanicolaou stain. Results: The study included total 349 female patients with breast lesion. Among these, non-neoplastic lesions were 183(52.44%) cases and neoplastic lesions were 166(47.56%) cases. Among the lesions, 105(30.08%) cases were in fibrocystic changes; 28(8.02%) cases were in non-suppurative mastitis; 24(6.87%) cases were in suppurative mastitis (abscess), 14(4.01%) cases were in granulomatous mastitis. About 45(42.88%) cases of Fibrocystic changes, 13(44.84%) cases of non-suppurative mastitis and 9(37.5%) cases of Suppurative mastitis (abscess) were in the age group 21 to 30 years, 21 to 30 years and 41 to 50 years respectively. Conclusion: Fibrocystic changes are the commonest lesion in this study. Journal of Monno Medical College June, 2024; 10 (1):07-12

Eco-logistical comparison of non-radioactive seeds and the wire-guided localization for intraoperative detection of breast lesions

BackgroundThe current standard for the preoperative marking of non-palpable breast lesions is wire guided localization (WGL) which is associated with logistical efforts and patient discomfort. Non-radioactive seeds (NRS) recently challenged the use of WGL; but do they provide a better alternative from a logistical and environmental perspective? MethodsWGL standard was compared with NRS available in Germany: Magseed®, Pintuition®, SAVI SCOUT ® and LOCalizer™ on a logistical and carbon-footprinting basis. In the logistical analysis the number of patient contacts with the healthcare system for lesion localization/removal and the number of breast punctures were evaluated in two different clinical scenarios (primary surgery and secondary surgery after neoadjuvant treatment). The carbon footprints of WGL and NRS (with exception of LOCalizer) were assessed based on their material compositions and operating energy in a streamlined approach. ResultsApplication of NRS reduces the number of contacts by 33.3 % (2 vs. 3) in primary, by 50 % (2 vs. 4) in secondary surgery, and the number of breast punctures by 33.3 % (2 vs.3). Annual Germany-wide material- and energy-based carbon footprints of NRS (1.6 to 3.2 tons CO2eq) are significantly lower in comparison to WGL (10.3 tons CO2eq). The implementation of NRS would lead to a CO2eq reduction by around 79 % compared to WGL. ConclusionsThe use of NRS for the localization of non palpable breast lesions is more favorable from the environmental and logistical perspective, when compared to WGL with possible benefits for patients, healthcare providers and the environment.

Granulomatous mastitis and other inflammatory mastitis simulating breast neoplasms – A retrospective study in the fine needle aspiration cytology clinic of a tertiary care center in eastern India

Background: Fine needle aspiration cytology (FNAC) is an important diagnostic modality in palpable breast lesions. This together with imaging modality is important in distinguishing benign from malignant lesions of the breast. Granulomatous/inflammatory mastitis forms a small subset of breast lesions that may present as a breast lump. Clinical and radiological features in these cases may mimic malignant breast pathology. Aims and Objectives: The aim of this study was to study the frequency of granulomatous mastitis and other inflammatory mastitis with respect to other neoplastic lesions of the breast, presented in FNAC clinics and to correlate the cytological findings with the clinical presentation of granulomatous and other inflammatory mastitis. Materials and Methods: A retrospective study was conducted in the Department of Pathology in a tertiary care center in Eastern India for duration of 4 years 5 months. Details of all patients who underwent FNAC for breast lesions during the study period were recorded in terms of their clinical presentation, cytological findings, imaging, and ancillary investigations. The findings were then tabulated in a master sheet and analysis done by descriptive statistics using SPSS 25. Results: A total of 154 cases were included with 5 cases (3.2%) of granulomatous and 12 cases (7.8%) of inflammatory mastitis. Age range for granulomatous/inflammatory mastitis was 20–70 years. Lump and pain were the most common complaints followed by inflammatory skin changes and nipple discharge. Very few cases also showed nipple retractions and very occasional systemic symptoms like fever. History of lactation was seen among five cases. Three cases showed positive acid-fast bacilli in Ziehl–Neelsen stain. Radiology was discordant with cytological findings in three cases, where the former suggested a breast neoplastic process. Conclusion: Granulomatous/inflammatory mastitis is a rarely diagnosed entity in breast cytopathology with no standard guidelines for management. Antibiotics antitubercular therapy and corticosteroids are some proposed lines of medical management. In treatment-resistant cases, wide local excision may be done depending on available resources and surveillance opportunities.

Correlation between Yokohama Cytological Coding and Radiological Findings and Their Diagnostic Accuracies against Histopathology: A Retrospective Study of Palpable Breast Lesions

Background: Breast carcinoma is the most common malignancy and demands quick and accurate diagnosis and treatment. Precise diagnosis of breast lesions is made using a triple-test approach: clinical, radiological and cytological. However, multiple steps make the process time-consuming and expensive. In developing countries like India, trained and certified radiologists are extremely overburdened. Fine needle aspiration cytology (FNAC) along with clinical examination can fill the gap. This study aims to correlate cytological, radiological and histological findings and measure their relative accuracies. Based on these findings, a new approach will be proposed to address the above shortcomings.Materials and methods: The FNAC was performed on all cases and reported as per Yokohama cytology. The cytological findings were correlated & validated against radiological and histopathological findings respectively. Relative performance of cytological and radiological findings were established using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy. A chi-square test for independence between cytological and radiological findings was performed.Results: The sensitivity, specificity, PPV, NPV, and accuracy for cytological findings come out as 97.60, 90.08, 90.37, 97.52, and 93.75, respectively. Meanwhile, the Radiological findings come out as 96.61, 82.20, 84.44, 96.04, and 89.41, respectively. The chi-square test demonstrates strong interdependence between cytological and radiological findings.Conclusion: FNAC is more accurate, quicker, and cheaper than radiological tests. Hence, FNAC based on the Yokohama system, along with clinical observations, can be used as a primary diagnosis tool in developing countries with limited health resources without making significant compromises on incorrect treatment. If needed, radiology and histopathology can be used for precise diagnosis and treatment.Keywords: FNAC, cytology, breast lesions, Yokohama, radiology, histopathology

Abstract PO5-08-10: Breast cancer risk prediction performance of polygenic risk score in Taiwanese female with dense breast: A nested case-control study

Abstract Introduction: Breast cancer is the most common cancer among women in Taiwan and the incidence rate of breast cancer has been increasing steadily over the past 30 years. To address this, a nationwide screening program with biennial mammography for women aged 40-69 was implemented in 2004, which has contributed to a significant reduction in breast cancer mortality. Asian women are more likely to have dense breast tissue, and studies have shown a correlation between breast density and the risk of developing breast cancer, with higher breast density values associated with increased risk. Polygenic risk scores (PRS) are calculated based on an individual's genetic information and can estimate their risk of developing a particular disease. Although PRS can identify low-penetrance risk variants, its use in breast cancer risk estimation is typically limited to gene-only models, and integration with breast cancer screening databases is rare. Hence, the aim of this specific study was to evaluate the predictive capacity of PRS in women with dense breast tissue by exploring potential genetic markers and constructing a PRS to investigate the genetic factors associated with clinical characteristics and the risk of developing breast cancer. Methods: The PRS was developed using genetic information from the Taiwan Precision Medicine Initiative genotyping data. A total of 6335 patients were enrolled, and 101 single nucleotide polymorphisms (SNPs) were selected as candidate markers based on the PGS Catalog (PGS000001). Clinical characteristics of the study cohort were summarised using median and range, or frequency and percentage. The distribution of characteristics between breast cancer and controls was estimated using an independent two-sample t-test, chi-square, and Fisher’s exact test. The association of the PRS and related characteristics with breast cancer risk in the study cohort was estimated using univariate and multivariate binomial logistic regression. Harrel’s C-index was reported to demonstrate the predictive performance of PRS in both univariate and multivariate models. All p-values were two-sided, and a p less than .05 is considered statistically significant. All analyses were performed using R 4.1.2 (R core team, 2023) Results: The results showed that breast cancer patients constituted a higher proportion of individuals in PRS Q4 (37.8% vs 24.8% in controls). The model's predictive performance for breast cancer risk increased from 0.565 (95% CI = 0.520-0.611) to 0.699 (95% CI = 0.644-0.755) by adding related clinical characteristics compared to the PRS-only model. Patients characterized with benign breast disease (OR = 0.50, 95% CI = 0.31-0.79, P = 0.004) showed a decreased breast cancer risk, and patients with mastalgia or palpable breast lesion (OR = 6.87, 95% CI = 4.29-10.8, P < 0.001) predicted significant greater breast cancer risk. Subgroup analysis of patients without breast symptoms was conducted as they may be overlooked or underestimated for breast cancer screening. For dense breast patients without symptoms, the high PRS group (Q4) consistently showed a significantly elevated breast cancer risk compared to the low PRS group (Q1-Q3) in both univariate (OR = 2.25, 95% CI = 1.43-3.50, P < 0.001) and multivariate analyses (OR = 2.22, 95% CI = 1.41-3.46, P < 0.001). Conclusion: Breast cancer screening has undergone a shift from a general approach to a personalized, risk-based approach. Besides breast cancer screening using family history as the only risk factor, our proposed model identifies both genetic and clinical risk factors using big data analyses including the EHR, cancer screening, and registry from a single institute. The study suggests that integrating PRS into personalized screening strategies could improve risk prediction for Taiwanese females with dense breasts without prominent symptoms. Table 1. Clinical characteristics of study cohort (n=6335). Table 2. Association of the PRS quartiles in breast cancer risk. Table 3. Predictive performance of PRS for breast cancer risk. Citation Format: Chih Yean Lum, Chih Chiang Hung, Chi-Cheng Huang, Tzu-Hung Hsiao, Sin-Hua Moi. Breast cancer risk prediction performance of polygenic risk score in Taiwanese female with dense breast: A nested case-control study [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-08-10.

Abstract PO5-07-09: ACCURACY OF STEREOTACTIC VACCUM-ASSISTED BREAST BIOPSY FOR INVESTIGATING SUSPICIOUS CALCIFICATIONS IN 2,021 PATIENTS A PUBLIC HOSPITAL IN BRAZIL

Abstract Backgroud: the gold standard for breast biopsy procedures is currently an open excision of the suspected lesion. The cost and morbidity associated with this procedure has prompted many physicians to evaluate less invasive, alternative procedures. More recently, image-guided percutaneous core-needle biopsy has become a frequently used method for diagnosing palpable and non-palpable breast lesions. Although sensitivity rates for core-needle biopsy are high, it has the disadvantage of histological underestimation. Vacuum-assisted stereotactic biopsy (VASB) was developed to overcome some of these negative aspects of core-needle biopsy. Objectives: to evaluate the accuracy of vacuum-assisted stereotactic biopsy (VASB) in the investigation of non palpable suspicious calcifications. Methods: it was a retrospective study from July 2012 to December 2020, in which 2,021 women with suspicious calcifications detected on mammography (BI-RADS 4 and 5) had VASB performed at Hospital Estadual Pérola Byington, São Paulo, Brazil. Fragments were obtained and sent to anatomopathological study; a metal clip was placed on the biopsy site. Four groups were analyzed, based on the biopsy results: benign, precursor lesions, Ductal Carcinoma In Situ (DCIS) and Invasive Ductal Carcinoma (ICD). Results: patients median age was 55y (49-63y). Pathology results on VASB were classified respectively as benign n=1,340 (66.3%), precursor lesions n=84 (4.1%), DCIS n=441 (21.8%) and ICD n=156 (7.7%). The 60 patients with results benign on VASB, because anatomopathological disagreement, surgery was performed, with the following results: benign n=30 (50%), ICD e DCIS n=21 (35%) e precursor lesions n=9 (15%). The sensitivity of the method was 91.7 %, specificity was 97.1%, false negative rate was 3%, positive predictive value was 92.4%, negative predictive value was 96.9%. Conclusion: the VASB method has a good accuracy to distinguish lower and higher risk lesions groups comparing to the gold standard. It has high predictive value in both benign and malignant lesions, guiding therapeutic planning. Keywords: Calcifications; Vacuum-assisted stereotactic biopsy; Breast cancer; Diagnosis. Citation Format: Andressa Amorim, Andre Mattar, Marcelo Antonini, Reginaldo Coelho Lopes, Luciana Damous, Luiz Henrique Gebrim, Marina Diogenes, Marcellus Ramos. ACCURACY OF STEREOTACTIC VACCUM-ASSISTED BREAST BIOPSY FOR INVESTIGATING SUSPICIOUS CALCIFICATIONS IN 2,021 PATIENTS A PUBLIC HOSPITAL IN BRAZIL [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-07-09.

O182: Tag localisation vs wire localisation: which is the more effective technique for localising non palpable breast lesions?

Abstract Introduction Following the expansion of breast screening programmes, non-palpable lesions comprise a challenge for accurate localisation. Placement of wires has been the historic gold standard of care. We aimed to compare wire-guided localisation (WGL) to radiofrequency identification system (RFID) LOCalizer(Hologic) with regards to resection margins and complications. Methods Data was collected retrospectively on patients who underwent breast conserving surgery for malignancy following localisation with LOCalizer RFID system or wire, in Beaumont Breast Centre, from January 2018 to March 2023. Lesion type, size, specimen weight, resection margins and complications were recorded and analysed. Results 690 were included in the study. 391 (57%) had a pre-operative diagnosis of malignancy: 88 in RFID tag guided localisation (TGL), 129 in mammogram wire guided localisation (MG-WGL) and 174 in ultrasound (US-WGL). The remaining had therapeutic excisional biopsy in which 18 (6%) were upgraded to in situ or invasive. Positive surgical margins were; US-WGL was 24% (43), MG-WGL was 23% (34) and TGL was 12% (11). Average tumour size was: 20.3mm US-WGL, 13.0mm MG-WGL, 18.3mm TGL. Average specimen weight for malignant cases were 33.8g US-WGL, 43.5g MG-WGL and 40.7g TGL. No significant complications were recorded in either group, however, a second localisation procedure was required for 14 patients in the TGL group and 10 patients in the WGL group. Conclusion TGL is a safe and effective alternative technique which allows greater flexibility in scheduling and increased efficiency. It has a learning curve which accounts for the slightly higher complication rate identified.

Comparison of trucut biopsy and postoperative specimens histopathological diagnosis of palpable breast lesions

Comparison of trucut biopsy and postoperative specimens histopathological diagnosis of palpable breast lesions

Evaluate role of High-Resolution Ultrasonography in evaluation of breast masses and its correlation with Fine Needle Aspiration Cytology

Introduction: Breast carcinoma is the most common malignant tumor among women. It contributes to a significant proportion of all cancers in women worldwide (25%). Ultrasound is a helper tool used in union with mammography and clinical examination of breast in breast lesion screening. In patients with dense breast tissue, USG is a valuable aid in picking up and characterizing lesions. It has a highly capable in spotting lesions but is poor in specificity. To boost specificity, the ACR introduced the BIRADS to categorize breast masses. Material and Methods: This is a prospective and observational study conducted in the Department of Radiodiagnosis, Al-Ameen medical college and Hospital from October 2021 to September 2022 presenting with complaints of palpable breast lesions and referred to the department of radiology. Structured proforma was used to collect the data. All the subjects who fulfilled the inclusion criteria were subjected to ultrasonography and FNAC. A high-resolution duplex Dopplersonography study using HITACHI ALOKA F-37 ultrasound machines with 5-13MHz linear transducer will be done. Results: In the study 20% had Family History of Breast Cancer. In the study on USG, margin was Circumscribed in 44%, 16% had indistinct, 28% had Micro lobulated and 12% had Spiculated. In the study on USG Echogenicity was Hypoechoic (66%), anechoic (24%), Complex cystic and solid (8%) and Isoechoic (2%). In the study on USG Posterior Echo Intensity was Post acoustic Enhancement in 18%, Shadowing in 30% and No, posterior features in 52%. In the study the study 96% had no infiltration and 4% had infiltration. In the study on Sono BIRADS, 46% were benign, 24% were Probably benign, 14% were Suspicious of malignancy and 16% were Highlysuspicious of malignancy. Conclusions: From the study it was concluded that High-Resolution Ultrasonography (BIRADS) had Sensitivity of 81.25%, specificity of 94.12%, PPV of 86.67%, NPV of 91.43%, Diagnostic Accuracy was 90%. Thus, USG is a reliable first line investigation in cases of breast lesions due to its good sensitivity and a primary diagnosis can be arrived at and the need for other investigations such as FNAC and Biopsy can be decided upon.

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.

Association of serum beta hCG levels in women with palpable malignant breast lesions

This study aims to determine whether serum Beta hCG can be used as a tumour marker in Breast malignancies. The objective of this study is to evaluate the serum Beta hCG in various stages of breast carcinoma and to correlate its level with disease severity and prognosis. Cross sectional analytical study of assessing serum Beta hCG in 200 patients with palpable breast malignancies at hospitals in urban Mangalore, India. In our study there was No increase in serum Beta hCG, in women with breast malignancies, but there was a pattern amongst the negative results. A Beta hCG of < 5mIU/mL is taken as negative, but in our study of 200 individuals, a mean value of 2mIU/mL was used as differentiation between low and high risk individuals. With our study we tried to correlate the value of Beta hCG with malignant breast lesions, and even though women with such lesions did not have a value of > 5mIU/mL, we found substantial evidence that women who had a value of > 2mIU/mL had a more advanced disease, be it in terms of staging, and comparing it with markers like ki67. A direct correlation between Beta hCG and severity of the disease in terms of staging was proved, hereby directly affecting the outcome of patients. Higher the level of Beta hCG, graver the prognosis. Even though Beta hCG cannot be used as tumour marker, it can be used to prognosticate the severity in women with palpable breast malignancies.

Triple assessment breast clinics: The value of clinical core biopsies

BackgroundTriple Assessment Breast Clinics are designed for rapid diagnosis of symptomatic patients. When there is no concordance between clinical and radiological assessment, clinicians perform clinical core biopsies. In patients with a clinically suspicious examination (S4, S5) and normal imaging, clinically guided core biopsy should be performed as per NCCP guidelines. However, substantial research does not exist on the diagnostic value or use of clinical core biopsies in non-suspicious palpable (S3) lesions and practices differ in each health system.AimsThe aim of this research was to assess the diagnostic value of clinical core biopsies in nonsuspicious, probably benign palpable breast lesions (S3) where image guided cores were not indicated (R1/R2).MethodsThe cohort consisted of patients undergoing clinical core biopsies at a Symptomatic Breast Unit from January 2014 to 2019. Data regarding patient demographics, outcome of triple-assessment and incidence of malignancy were obtained from a prospectively maintained database and results were analysed using Minitab 2018.ResultsThree hundred and sixty patients had a clinical core biopsy performed in this period. Clinical examination scores for these patients were S1/S2 (66), S3 (277), S4 (15), and S5 (2). Radiology Scores were R1/R2 (355) and R3(5). Two patients with clinical score S3 (0.6%) were diagnosed with breast cancer due to their clinical cores. Both patients had normal mass imaging. There was no association between uncertain palpable breast lesions (S3), and atypia or malignancy on biopsy results when breast imaging was normal (P = 0.43, χ2 test).ConclusionDespite clinical core biopsies being used in triple assessment, there is no certainty in their value except that there is high clinical suspicion. Imaging modalities are constantly improving and are already well established. When the patient is assigned a clinical score of S3 and has normal radiology, a clinical core biopsy is not required in most cases.

Sono-mammography assisted wire guided localization of non- palpable breast lesions

Sono-mammography assisted wire guided localization of non- palpable breast lesions

Dynamic contrast-enhanced MRI and Apparent diffusion coefficient mapping in the characterization of Palpable breast lesions: A prospective observational study

BackgroundBreast MRI is the imaging modality of choice in patients with palpable breast lesions unequivocal on mammography and ultrasonography. This study aims to evaluate the role of dynamic contrast-enhanced MRI (DCE-MRI) and apparent diffusion coefficient mapping in the characterization and differentiation of various palpable breast lesions. This prospective observational study was conducted in a tertiary care hospital between July 2019 and June 2021. Sixty-six patients with palpable breast lesions were undergone MRI scans of the breasts. The various palpable breast lesions were categorized according to the 5th edition BI-RADS lexicon. The sensitivity of ADC mapping and DCE-MRI was determined for differentiation of various palpable breast lesions according to the BI-RADS category and gold standard histopathological findings.ResultsOf 66 patients with palpable breast lesions, 36 patients (54.5%) were benign and 30 patients (45.5%) were malignant lesions. Malignant palpable breast lesions had a mean ADC value of 0.939 ± 0.166[SD] × 10−3 mm2/s, and benign lesions had 1.891 ± 0.524[SD] × 10−3 mm2/s where unpaired Student t-test showed statistically significant difference of P value 0.0005. BI-RADS 2 lesions had a mean ADC value of 2.056 ± 0.471[SD] × 10−3 mm2/s, BI-RADS 3 had 1.314 ± 0.151[SD] × 10−3 mm2/s, BI-RADS 4 had 0.935 ± 0.119[SD] × 10−3 mm2/s, and BI-RADS 5 had 0.930 ± 0.943[SD] × 10−3 mm2/s. BI-RADS 2 category showed optimal cutoff mean ADC of 1.508 × 10−3 mm2/s with a sensitivity of 85.7% and specificity of 94.7%, BI-RADS 3 lesions had 1.208 × 10−3 mm2/s with a sensitivity of 75% and specificity of 55.2%, BI-RADS 4 lesions had 1.064 × 10−3 mm2/s with a sensitivity 80% and specificity of 67.9%, and BI-RADS 5 lesions had 1.013 × 10−3 mm2/s with a sensitivity of 80% and specificity of 82.6%.ConclusionsBreast MRI is superior to the other imaging modalities for the characterization and differentiation of various palpable breast lesions. The combined use of ADC mapping and DCE-MRI had more sensitivity than conventional MRI, ADC mapping or DCE-MRI alone.

Wires or tags? Localising non palpable breast lesions in a district general hospital

Wires or tags? Localising non palpable breast lesions in a district general hospital

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.

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&amp;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.

Advantages of the cell block technique over the FNAC and correlation with histopathology of most prevalent breast lesions in the community at the tertiary care center

Breast lumps are a common cause of concern in both young and older women throughout the world. Fine needle aspiration of breast lesions is an important and widely practiced method of providing a preoperative diagnosis in women presenting with a lump in the breast. Cell blocks that are made from the aspirates help in preserving the architecture, and the nuclear morphology and help in preserving the material for immunohistochemical studies. The present study aims to highlight the role of FNAC and cell block in the diagnosis of breast lesions. This was a two-year prospective study of 72 patients presenting with palpable breast lesions referred for FNAC to the Department of Pathology JJMMC, Davangere from 1st July 2015 to 30th June 2017. After a detailed history, general physical &amp; local examination, informed consent was taken and FNAC was performed under aseptic precautions. A part of the aspirate was fixed, then processed as cell blocks, and stained with H&amp;E. Wherever lumpectomy or radical surgery was performed the histopathology was correlated with cytomorphological findings.: The present study showed a diagnostic accuracy of 85.71% in the FNAC diagnosis. The sensitivity and specificity of FNAC in diagnosing breast lesions were found to be 82.60% and 87.23%. PPV and NPV were 76% and 91.11% respectively. When cell blocks were used the diagnostic accuracy increased to 88.57%. Diagnosis by using cell block showed a sensitivity of 79% specificity of 93.47%, PPV of 86.36%, and NPV of 89.58%.: From the results of our study, it can be concluded that the accuracy of diagnosing breast lesions preoperatively can be increased when FNAC is combined with the cell blocks from the aspirates. The cell blocks also help to preserve the aspirated material for future reference and immunohistochemistry can also be applied for a more accurate diagnosis.

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.

Correlation of Mammography, Ultrasound and Sonoelastographic Findings With Histopathological Diagnosis in Breast Lesions.

Introduction Breast masses range from inflammatory and benign to malignant lesions, varying in different age groups and clinical presentations. Breast imaging techniques leading to prompt and specific diagnosis have been a lifesaver for millions around the globe saving them undue mental stress in inflammatory lesions and preventing early death in case of neoplasms. Here, we compare mammography, ultrasonography (US) and ultrasound elastography in the screening and diagnosis of breast lesions and the usefulness of strain ratio as a non-invasive tool in diagnosing breast malignancies. Aims and objectives Determining the characteristics ofbreast lesions on imaging by mammogram, ultrasonography, elastography, calculating strain ratio andcorrelating them with histopathology. To further estimate the advantages and limitations of one modality over the other in the evaluation of breast lesions. Methods The study was done over a duration of 18 months from November 2019 to June 2021 at JSS Medical College and Hospital, Mysuru. In this prospective study, 73 female patients with palpable breast lesions were evaluated using mammography, US and sonoelastography and were co-related with histopathological findings. Results This study has proved that the use of ultrasound elastography has higher sensitivity (91.67% with strain ratio kept at 3) in detecting malignant lesions when compared with x-ray mammography and ultrasonography having a sensitivity of 87.88% and 90.91%, respectively. Our study confirmed that there is a correlation between strain ratio and histopathological findings and that the strain ratio has high sensitivity in diagnosing and differentiating malignant breast lesions. Conclusions Mammography, US and sonoelastography when combined together are helpful in characterization and management of breast lesions. This helps to avoid unnecessary invasive interventions. The specificity of the study in detecting malignant lesions was comparable with that of histopathological analysis.