Prospective study of fine needle aspiration cytology of clinically palpable breast lump with histopathological correlation

Authors

  • Ashwin K. Hebbar Assistant Professor, Department of General Surgery, Shimoga Institute of Medical Sciences, Shimoga, Karnataka
  • Harish Iyanna Senior Resident, Department of General Surgery, Shimoga Institute of Medical Sciences, Shimoga, Karnataka

Keywords:

FNAC, Breast lump, Carcinoma breast, Diagnosis of breast lump

Abstract

Background and objectives:  This study was conducted to compare the diagnostic accuracy of fine needle aspiration cytology in differentiating the benign and malignant lesions of palpable breast lump with histopathological correlation and also to study the accuracy of the needle tip localizing the tumor during fine needle aspiration cytology procedure.

Methods: Two years prospective study was conducted in our institution and in that 100 patients underwent fine needle aspiration cytology of the palpable breast lump after thorough physical examination. The cytological diagnosis was classified in to 3 groups benign, suspicious and malignant. After this reporting all the patients were later subjected to open/excision biopsy and its histopathological confirmation. Later diagnostic accuracy of cytology reporting was compared with that of histopathology. Accuracy of the needle tip in localizing the tumor in fine needle aspiration cytology was also studied by comparing the normal glandular cell aspirate with tumor cell aspirate. Repeat cytology was carried out before open/excision biopsy if the pathologist reports the cytology slide as “inadequate”.

Results: We had accuracy rate of 100% for benign lesion and 93.10% for malignant lesion with false negative rate of 6.9% and false positive rate of zero with fine needle aspiration cytology in the diagnosis of palpable breast lump. The overall sensitivity of fine needle aspiration in diagnosing the palpable breast lump is 93.10%, specificity is 100%, positive predictive value is 100% and negative predictive value is 90.47%. Since inadequate sampling rate is 2% in our study, the accuracy rate of needle tip in localizing the tumor in fine needle aspiration cytology is 98%.

Conclusion: Since our diagnostic accuracy rate and predictive values are very high and comparable to any other published series it can be advised that the patients in which fine needle aspiration cytology is unequivocally diagnostic for cancer can be managed directly by mastectomy (or any other definitive therapy). A diagnosis of suspicious for cancer must be confirmed by an open biopsy or intraoperative frozen section or rapid hemotoxyline and eosine staining (depending on availability). Since the accuracy of the needle tip in localizing the lump is very high (98%), the diagnostic accuracy of fine needle aspiration cytology can be increased by performing repeat aspiration on the lump for which previously being reported as inadequate or unsatisfactory sampling before advising for open biopsy.

References

William H. Hindle et al. The use of fine needle aspiration in the evaluation of persistent palpable dominant breast masses. American Journal of Obstetrics and Gynecology 1993; 168:1815-1819.

Johnson et al. Breast fine needle aspiration cytology and core biopsy: a guide for practice. Cancer 2003;19:203-208.

Reshma Ariga et al. Fine needle aspiration of clinically suspicious palpable breast mass with histopathological correlation. American Journal of Surgery 2002; 184:410-413.

Mark Rubin et al. Use of fine needle aspiration for solid breast lesion is accurate and cost effective. American journal of surgery 1997; 174:694-698.

Dennison et al. A Prospective Study of the Use of Fine Needle Aspiration Cytology and Core Biopsy in the Diagnosis of Breast Cancer. British Journal of Surgery 2003; 9:491-497.

Dixon et al. Fine needle aspiration cytology in relationship to clinical examination and mammography in the diagnosis of a solid breast mass. British Journal of Surgery 1978; 71:593-596.

Silverberg Delvillis Frable. Principle in Practice and Surgical Pathology and Cytopathology, 3rd edition, Singapore, Churchill Livingstone 1997; 578-584.

Andrew Saxe et al. Role of sample adequacy in fine needle aspiration biopsy of palpable breast lesions. American journal of surgery 2001; 182:369-371.

Michael Shabot. Aspiration Cytology is Superior to Tru-cut Needle Biopsy in Establishing the Diagnosis of Clinically Suspicious Breast Masses. Annals of Surgery 1982; 196:122-126.

Franzen S, Zajoak J. Aspiration biopsy in diagnosis of palpable lesions of the breast. Acta Radiol 1968; 7:241-262.

Editorial Opinion. The Uniform Approach to Breast Fine Needle Aspiration Biopsy. American Journal of Surgery 1997; 173:371-383.

Hussain M T. Comparison of fine needle aspiration cytology with excision biopsy of breast lump. J Coll Physicians Surg Pak 2005; 15(4): 211-214.

Parson C A. Diagnosis of breast diseases, 1st edition, Singapore, Churchill Livingstone 1990; 201-203.

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Published

2017-01-27

How to Cite

Hebbar, A. K., & Iyanna, H. (2017). Prospective study of fine needle aspiration cytology of clinically palpable breast lump with histopathological correlation. International Journal of Research in Medical Sciences, 1(3), 257–262. Retrieved from https://www.msjonline.org/index.php/ijrms/article/view/2602

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Original Research Articles