Utility of fine-needle aspiration as a diagnostic technique in breast lumps

Cytomorphological patterns of palpable breast lesions diagnosed on fine needle aspiration cytology in females

Breast cancer is the most common malignant tumor and is a leading cause of death worldwide. This study was planned to find out the frequencies of various types of lesions from palpable breasts of female patients through fine needle aspiration cytology. This retrospective study was carried out during December 2017 to May 2018 on 100 female patients presenting with palpable breast mass at University Medical Complex & Research Center, Sargodha, Pakistan. Following written informed consent from patients, a detailed history, patient age, and clinical examination were recorded. The fine needle aspiration cytology was performed and aspirates were processed following the standard methods for cytopathological examination. The cases were grouped according to the five tier reporting format for breast lesion (C1–C5) laid down by the International Academy of Cytologists (IAC) in 2016. The spectrum of breast lesions on cytomorphological interpretation was 54% benign (C2), 2% atypia/suspicious probably benign (C3), 3% suspicious probably malignant (C4) and 41% malignant (C5). Inadequate/insufficient material (C1) was not included in the study. In this study, the specificity, sensitivity, negative and positive predictive value, and diagnostic accuracy of fine needle aspiration cytology were 100%, 91.11%, 98.18%, 100%, and 98.96%, respectively. In benign lesions, maximum cases were of fibroadenoma (24%) followed by fibrocystic disease (4%), lipoma (3%) while benign phyllodes tumor and galactocele were only 1% each. Breast mass was the chief presenting complaint. Breast cancer was commonest among all the morphological patterns of breast lesions followed by fibroadenoma. This study supports that cytological examination using fine needle aspiration cytology is an economical, rapid, easy and valuable diagnostic tool.

Fine-needle aspiration and core biopsy in the diagnosis of breast lesions: A comparison and review of the literature

In recent times, the diagnosis of breast lesions has mostly become dependent on core needle biopsies (CNBs) with a gradual reduction in the rate of performing fine-needle aspiration cytology (FNAC). Both the procedures have their pros and cons and outsmart each other taking into account different parameters. Both the methods are found to be fraught with loopholes, taking into account different performance indices, diagnostic accuracy and concordance, patient benefit, and cost-effectiveness. Unlike the popular belief of an absolute superiority of CNB over FNAC, the literature review does not reveal a very distinct demarcation in many aspects. We recommend judicious use of these diagnostic modalities in resource-limited settings and screening programs taking into account parameters such as palpability and availability of an experienced cytopathologist.

Cytomorphology of palpable breast lesions: Diagnostic utility of FNAC in a developing country

BACKGROUND

Breast lesions including breast cancer represent a major public health issue in Sudan. Fine-needle aspiration cytology (FNAC) is an established, simple, highly accurate, minimally invasive, and cost-effective method of diagnosing most breast lesions. The aim of this study is to document the most common breast conditions diagnosed by means of FNAC over a two-year period in Atbara, a city in north Sudan.

METHODS

A retrospective, descriptive, cross-sectional, laboratory-based study in which records of all palpable breast lesions diagnosed by FNAC in the years 2012 and 2013 were reviewed and analyzed.

RESULTS

The total number of cases studied was 232; most subjects, 222 (95.7%), were females. The age range was 15-90 years (mean 38.2). Painless lump was the most common 190 (81.9%) clinical presentation. The left breast was affected more often than the right breast, 56.0% vs. 40.5%. Benign conditions were 167 (72%). Malignant neoplasms were 65 (28.0%). The most important associations with malignancy were female sex, age above 35 years, multiparity, painless lump at upper outer quadrant of left breast, lump size above 2 cm and the presence of an enlarged ipsilateral axillary lymph node at presentation.

CONCLUSION

In the northern part of Sudan, the prevalence of malignant breast lesions diagnosed by FNAC is more than one fourth of all cases presenting with palpable breast lumps. FNAC is a technique that is ideal for use in resource-limited health settings.

Pattern of palpable breast lesions on fine needle aspiration: A retrospective analysis of 902 cases

Background:

Breast lumps constitute a significant proportion of surgical cases in women of both developed and developing countries. The aim of this study is to look the frequency distribution of various breast lesions on fine needle aspiration (FNA).

Materials and Methods:

The 902 patients who presented with palpable breast lump, irrespective of age and sex were included in the study. Frequency distribution of various breast lesions with respect to age and sex was studied. Cytology grading in breast carcinoma was correlated in 69 cases with histology grading.

Results:

The majority (N = 871) of patients were females with maximum (N = 566) patients between second and third decade. The 773 patients had benign breast lesions and maximum (N = 341) patients were in the second decade. Fibroadenoma was the commonest benign lesion followed by fibrocystic change and mastitis. Out of 119 malignant breast lesions, 31.93% [N = 38] were between 41-50 years of age, 28.57% [N = 34] in 51-60 years and 22.68% [N = 27] in between 31-40 years of age. Out of 119 malignant breast lumps and majority were infiltrating ductal carcinoma (N = 108). Cytology grading correlated maximum with histology grade in Grade I followed by Grade II and Grade III.

Conclusion:

With experienced hands, FNA is safe, cost effective and a reliable technique for preoperative evaluation of palpable breast lumps. FNA features are more informative when combined with physical and radiology findings (Triple test). Fibroadenoma, fibrocystic change and mastitis form the major bulk of benign breast lesions. Epithelioid cells when seen in inflammatory breast FNA smears, tuberculosis must be ruled out. In India, breast carcinoma arises in younger patients as compared to western countries. Grading of breast carcinomas must be done on FNA smears for selecting neoadjuvent therapy. Clinical breast examination and mammography screening in females should be encouraged in developing countries from the third decade onwards for early detection of breast carcinoma.

Expression of Ki-67 and p27(Kip1) in fine-needle aspirates from breast carcinoma and benign breast diseases

Cell atypia in breast fine needle aspiration (FNA) can introduce some diagnostic difficulties. Molecules reflecting proliferative cell potential, such as Ki-67 and p27(Kip1) , can help in recognizing the true biological nature of a cell. Thus, the objective of the study was to analyze the difference in Ki-67 and p27(Kip1) cell immunoexpression in breast FNA specimens between fibroadenomas, fibrocystic changes (FCC) with atypia, and breast carcinoma. Microscopic analyses of cell cytomorphology and Ki-67 and p27(Kip1) breast cell immunoexpression were done after standard Pappenheim and immunocytochemical staining (labeled streptavidin-biotin, LSAB) method in autostainer DakoCytomation TechMate™. The study included 50 patients with breast carcinoma, 20 patients with fibroadenoma, and 20 patients with FCC with atypia. High Ki-67 and low or absent p27(Kip1) were found in most patients with breast carcinoma, while majority of FCC with atypia were characterized by low Ki-67 and moderate to high p27(Kip1) cell immunoexpression. Majority of fibroadenomas were associated with low Ki-67 and low to moderate p27(Kip1) cell immunoexpression indicating progressive decrease in cell cycle inhibition, but still not so high proliferative activity as in carcinoma. However, although statistically significant difference for Ki-67 and p27(Kip1) was found between breast lesions in our study, the large ranges observed for each marker make them essentially useless for better cytological diagnosis in a single case. Regarding their opposite role in cell cycle, inverse correlation of Ki-67 and p27(Kip1) was noticed. Poorly differentiated carcinoma cells had mostly high Ki-67 and low p27(Kip1) cell immunoexpression.