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

Cytomorphological patterns of breast lesions among women with palpable breast lumps attending select teaching and referral hospitals in Kenya: a descriptive cross-sectional study

Introduction

breast lumps account for a greater number of lesions in women attending surgical clinics in the developing world. Breast cancer which mostly presents as a breast lump is the leading cancer in Kenya, with an incidence of 12.5%. The study aims to describe the patterns of breast lesions in women presenting with palpable breast lumps in two major referral hospitals in Kenya.

Methods

seven hundred and sixty-eight study participants with palpable lumps underwent fine needle aspiration cytology (FNAC). Sociodemographic data were captured using structured questionnaires. The FNAC materials were evaluated using the International Academy of Cytology Yokohama System (IACYS) and the lesions were classified into five-tier categories. Frequencies and percentages were used to summarize qualitative variables.

Results

of 768 smears, 84.8% (n=651) were adequate for evaluation while 15.2% (n=117) were inadequate. Neoplastic lesions comprised 84.5% (n=550) and non-neoplastic 15.5% (n=101). Benign lesions accounted for 83.6% of the lesions followed by breast carcinoma (10.4%). Ductal carcinoma comprised 98.5% of cancerous lesions. The age group most affected with ductal carcinoma and suspicious lesions was 20-34 years (37.3% and 55.6% respectively). Fibroadenoma formed the bulk of the benign lesions identified (44.1%). Suspicious of malignancy was 4.1% (n=27). The age group with the most lesions (47.5%) was 20-34 years.

Conclusion

a wide spectrum of breast lesions was established. Such include inflammatory, atypical, benign, suspicious of malignancy, and malignant lesions. Fibroadenoma was a common lesion diagnosed. The age group most affected by malignant lesions was 16-49 years, necessitating enhanced screening of women with breast lumps in our setups.

Utility of ultrasound guided versus conventional fine needle aspiration cytology in diagnosing breast malignancies among patients with palpable breast lumps at Bugando Medical Centre, Mwanza Tanzania

Introduction

breast lump is the commonest presentation for both benign and maligant breast conditions. Both ultrasound guided and conventional fine needle aspiration cytology (FNAC) have been used for diagnosing of breast malignancy among patients with palpable breast lumps. This study compared diagnostic utility of ultrasound guided versus conventional FNAC in diagnosing breast malignancies among patients with palpable breast lumps at Bugando Medical Centre.

Methods

this was a hospital based cross sectional study with a follow up component that combined both retrospective data (from January 2017 to June 2018) and prospective data (from July 2018 to June 2019).

Results

during the study, total of 354 patients (male; female = 1: 32) were enrolled in the study. A total of 134 (37.9%) patients had malignant lesions while 220 (62.1%) of patients had benign lesions confirmed on histology. The diagnostic utility (sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy) for conventional FNAC was 86.7%, 95.7%, 93.5%, 91.1% and 92.0% with an 8% error margin versus ultrasound guided FNAC all were 100% with a 0% error margin respectively.

Conclusion

both ultrasound guided and conventional FNAC show almost perfect agreement with histology. However, ultrasound guided FNAC has a higher diagnostic utility relative to conventional FNAC in diagnosing breast malignancies.

Fine-Needle Aspiration Cytology in the Diagnosis of Breast Paraffinoma

INTRODUCTION

Paraffin injections for breast augmentation once a popular form of mammoplasty are now considered obsolete. It had been abandoned by clinicians because of its associated serious complications. The practice is however still available and is being practiced by nonmedically qualified people. Paraffin injection results in the formation of multiple foreign-body granulomas known as breast paraffinoma. The clinical features of breast paraffinoma can mimic and be mistaken for breast carcinoma or inflammatory breast carcinoma. The use of fine-needle aspiration cytology (FNAC) in the evaluation of patients with breast paraffinoma has not been fully evaluated.

METHODS

Retrospective review was performed on 30 patients who presented with breast paraffinoma between June 1, 2010, and June 30, 2020, who also had FNAC as part of their breast lump evaluation.

RESULTS

FNAC of 73.3% patients showed multinucleated giant cells and macrophages or histiocytes containing engulfed clear, empty intracytoplasmic vacuoles of varying sizes. In 13.3% of the patients, macrophages or histiocytes with engulfed clear intracytoplasmic vacuoles of varying sizes were seen. In 6.7% of patients, multinucleated giant cells containing engulfed vacuoles of varying sizes were seen, and in 6.7% of patients, hypocellular smears with large amount of clear spaces were seen. Oily droplets were seen in the background of all the smears, and there were no malignant cells seen. These features were compatible with breast paraffinoma.

CONCLUSION

Most patients with breast paraffinoma can be managed conservatively and they do not require further treatment; FNAC with its characteristic features can provide the reliable diagnosis of breast paraffinoma and therefore sparing these patients from more invasive diagnostic procedures.

Palpable Breast Lump Triage by Minimally Trained Operators in Mexico Using Computer-Assisted Diagnosis and Low-Cost Ultrasound

Purpose

In low- to middle-income countries (LMICs), most breast cancers present as palpable lumps; however, most palpable lumps are benign. We have developed artificial intelligence–based computer-assisted diagnosis (CADx) for an existing low-cost portable ultrasound system to triage which lumps need further evaluation and which are clearly benign. This pilot study was conducted to demonstrate that this approach can be successfully used by minimally trained health care workers in an LMIC country.

Patients and Methods

We recruited and trained three nonradiologist health care workers to participate in an institutional review board–approved, Health Insurance Portability and Accountability Act–compliant pilot study in Jalisco, Mexico, to determine whether they could use portable ultrasound (GE Vscan Dual Probe) to acquire images of palpable breast lumps of adequate quality for accurate computer analysis. Images from 32 women with 32 breast masses were then analyzed with a triage-CADx system, generating an output of benign or suspicious (biopsy recommended). Triage-CADx outputs were compared with radiologist readings.

Results

The nonradiologists were able to acquire adequate images. Triage by the CADx software was as accurate as assessment by specialist radiologists, with two (100%) of two cancers considered suspicious and 30 (100%) of 30 benign lesions classified as benign.

Conclusion

A portable ultrasound system with CADx software can be successfully used by first-level health care workers to triage palpable breast lumps. These results open up the possibility of implementing practical, cost-effective triage of palpable breast lumps, ensuring that scarce resources can be dedicated to suspicious lesions requiring further workup.

High-selectivity cytology via lab-on-a-disc western blotting of individual cells

Cytology of sparingly available cell samples from both clinical and experimental settings would benefit from high-selectivity protein tools. To minimize cell handling losses in sparse samples, we design a multi-stage assay using a lab-on-a-disc that integrates cell handling and subsequent single-cell western blotting (scWestern). As the two-layer microfluidic device rotates, the induced centrifugal force directs dissociated cells to dams, which in turn localize the cells over microwells. Cells then sediment into the microwells, where the cells are lysed and subjected to scWestern. Taking into account cell losses from loading, centrifugation, and lysis-buffer exchange, our lab-on-a-disc device handles cell samples with as few as 200 cells with 75% cell settling efficiencies. Over 70% of microwells contain single cells after the centrifugation. In addition to cell settling efficiency, cell-size filtration from a mixed population of two cell lines is also realized by tuning the cell time-of-flight during centrifugation (58.4% settling efficiency with 6.4% impurity). Following the upstream cell handling, scWestern analysis detects four proteins (GFP, β-TUB, GAPDH, and STAT3) in a glioblastoma cell line. By integrating the lab-on-a-disc cell preparation and scWestern analysis, our platform measures proteins from sparse cell samples at single-cell resolution.