Diagnostic evaluation of Breast lumps and its cyto–histological correlation

Kulashekhar Bhattacharjee; Damodar Chatterjee; Nupur Moitra

Volume : V, Issue : III, March - 2016

Diagnostic evaluation of Breast lumps and its cyto–histological correlation

Kulashekhar Bhattacharjee, Damodar Chatterjee, Nupur Moitra

Abstract :

Background & Objectives: Breast lumps have varied pathology, and there are different techniques to prove its diagnosis. In India a large number of patients have been suffering from east cancer and with each passing year, the number is increasing. Fine needle aspiration cytology (FNAC) is a noninvasive, inexpensive, simple, safe and highly accurate technique of diagnosing both benign and malignant east lesions. It has high sensitivity and specificity. The procedure provides a rapid and non–morbid diagnosis before the operation thus enabling the patient and the surgeon to discuss and plan the treatment modalities rationally. The aim of the present study is to find out the common causes of east lesions, their risk categorization for development of cancer and to analyze the role of fine needle aspiration cytology (FNAC) of the east lesions and to correlate the cytological findings of east lumps with their histomorphological diagnosis on excision at our centre. In addition the sensitivity, specificity, positive & negative predictive value of FNAC in east lesions are carried out. Methods: This comparative study was conducted in the Department of Pathology, AGMC & GBP Hospital, Agartala, Tripura, India from December, 2013 to June, 2015. Four hundred and sixty eight (468) patients came to the Department of Surgery, AGMC & GBP Hospital, Agartala, Tripura, India in two years who had a clinically palpable east lump and was referred and subjected to fine needle aspiration cytology (FNAC). The smears were stained with Papanicolaou, H&E, May–Grunewald Giemsa stain and special stains like ZN & PAS wherever necessary and were examined under light microscope and categorized as inadequate/unsatisfactory sample, benign inflammatory, benign proliferative, atypical/suspicious and malignant. FNAC diagnosis was compared with histological diagnosis to see the accuracy of fine needle aspiration cytology for neoplastic lesions. Results: Four hundred sixty eight patients who presented with a east lump in the outpatient department (OPD) of Department of Surgery at AGMC & GBP Hospital were referred to the Pathology department for FNAC. Out of 468 cases, 11 were inadequate aspirations (adequacy 97.6%). Invasive ductal carcinoma was the most commonly reported lesion with maximum incidence in the 4th, 5th and 6th decades followed by invasive lobular carcinoma and other malignant lesions. Out of 457 east aspiration (adequate), 301 cases showed non–neoplastic pathology. Out of which 109 smears were inflammatory and the most commonly encountered inflammatory lesions were acute mastitis or abscess (35.8%), All these cases were further confirmed by special stains (PAS, Zn) and cell block preparations and thus excluded from histopathological study.192 smears were reported as benign proliferative lesions , 44 as suspicious for malignant and 112 cases were reported as malignant lesions. Histopathological studies of all these cases were performed out of which 191 cases were benign while 1 case turned out to be malignant phyllodes tumor of the east ( false negative).Out of 44 suspicious for malignancy cases, 5 cases turned out to be benign lesion on histopathology ( false positive). All the 112 cases which were diagnosed as malignant lesion on FNAC proved to be malignant on histopathology. Fioadenoma was the commonest benign lesion noted in the age group 21–30 years and infiltrating duct carcinoma was the most common malignant lesion. The sensitivity, specificity, accuracy, negative predictive value and the positive predictive value of FNAC was 99.3%, 97.4%, 98.2%, 99.5% and 96.8% respectively. Our results were correlated with previous studies. Conclusion: Breast cytology is an effective and rapid method of diagnosis of east diseases. It helps in deciding which patient needs an early open biopsy. FNAC serves as an economical and reliable tool for the diagnosis of palpable east lesions because the cytopathological examination of these lesions before operation or treatment serves as an important diagnostic modality. FNAC of non–neoplastic lesions enjoyed utmost sensitivity & specificity and turned out to be cost effective procedure for diagnosis. Cytology helped in avoiding unnecessary surgery in 45% cases. The FNAC of east is cheap, safe and highly accurate preoperative method for diagnosis of east lesions. Preoperative categorization of east lesions is of utmost importance for the management of the patient.