Cytomorphological study of spectrum of breast lesions and determination of efficacy of FNAC in the diagnosis of various breast lesions.
MATERIALS AND METHODS: Aim of the study was to study the cytomorphological spectrum of breast lesions on Fine needle aspiration cytology (FNAC).
A total of 512 cases were included in the study. The period of study was from January 2014 to December 2014.
Inclusion Criteria: All patients presenting with palpable breast lump of variable duration.
1. Patients not willing (No informed consent).
2. Patients undergoing chemotherapy.
PROCEDURE: A written consent was taken from the patient along with detailed history. The breast was examined and palpated. The suspicious area was cleaned with antiseptic solution and spirit. The skin over the lump was stretched and multiple passes at different angles were taken with a 10 or 20 cc syringe fitted with a 22 G needle. The aspirated material was smeared on the glass slides. Few of them were air dried and stained by May Grunwald Giemsa (MGG) stain and the rest were stained with Hematoxylin & Eosin (H&E) stain.
RESULTS: The patient's age group ranged from 16 to 87 years with a mean age of 34.54 years. The commonest age group was 21-30 years comprising 197 cases (38.47%) with 31-40 years age group following it in the second position with 131 cases (25.6%).
There were 6 male patients and 506 female patients. Of the 6 male patients, 4 were diagnosed with gynaecomastia and 2 with carcinoma.
Among the category of lesions, the highest incidence recorded was of fibroadenoma (Fig. 1) (184=35.9%) that was followed by carcinoma (90=17.5%) and then by benign breast disease and fibrocystic disease with 79 and 48 cases respectively. Among carcinoma cases, 88 were classified as ductal carcinomas (Fig. 2, 3) and 02 as mucinous carcinomas (Fig. 4). Inflammatory lesions accounted for 65 cases (12.7%), which included 40 cases of abscess (Fig. 5), 20 cases of granulomatous mastitis and 05 cases of chronic mastitis. All 20 cases of granulomatous mastitis were non-caseating. (Table 1) 04 cases were categorized into Atypical Ductal Hyperplasia (ADH)/Ductal Carcinoma in Situ (DCIS) and 05 cases were classified as suspicious of malignancy. (Table 1)
Maximum incidence of fibroadenoma was found in age group of 21-30 years (87 cases) and the maximum incidence of carcinoma was found in 31-50 years (59 cases).
10 cases (1.95%) designated as others included duct ectasia, gynaecomastia and fatty aspirates. (Table 1)
The mean age for malignant cases was 43.24+- 14.45 years.
38 of 90 cases classified as malignant showed enlarged and palpable axillary lymph nodes. 09 (10%) of these cases showed metastatic deposits whereas 29 (32.2%) showed reactive changes. (Table 2).
DISCUSSION: FNAC is a sensitive, rapid, cost effective and a safe method in the evaluation of palpable breast lumps. It is less traumatic and provides immediate report to the patient and therefore is a widely accepted method of analyzing various breast lesions [2,4,5,6,7,8,9] Proof of malignancy is the usual aim of such a procedure although it can be used for diagnosis of benign lesions as well as some inflammatory conditions [5,7,8]
The present study comprised of 529 aspirations performed on 512 patients. In 17 cases (3.2%), a second pass was needed, as the material was inadequate in the first instance. The aspiration was repeated in these cases as there was a strong suspicion of malignancy on clinical and radiological examination.13% of repeat aspirations have been cited in different studies because of an inconclusive first aspiration. It is also stated that an unsatisfactory aspiration must be repeated, particularly when there is strong suspicion of possible malignancy.  In 4 cases (0.8%), the material was inadequate for interpretation and aspiration yielded only fatty material in spite of the repeat aspiration.
In this study, the population ranged from 16 to 87 years with a mean age of 34.54 years. The commonest age group was 21-30 years comprising 197 cases (38.47%) with 31-40 years age group following it in the second position with 131 cases (25.6%). Similar results have been seen in other studies too. The mean age for malignant cases was 43.24[+ or -]14.45 years [1,2,3,4,5,8,9,11,12,13]
In the present study, 90 cases were positive for malignancy (17.5%). 04 cases (0.78%) were categorized into Atypical Ductal Hyperplasia (ADH)/Ductal Carcinoma in Situ (DCIS) and 05 cases were classified as suspicious of malignancy (0.97%). All of these 05 cases were later confirmed as malignant on histopathology. These were classified as suspicious as on FNAC, all the cytological features of malignancy were not present. Maximum incidence of carcinoma was found in 31-50 years (59 cases). Similar results regarding the percentage of cases positive for malignancy have been reported in various other studies[1,2,4,5,9,11,12,13,14]
38 of 90 cases classified as malignant showed enlarged and palpable axillary lymph nodes. 09 (10%) of these cases showed metastatic deposits whereas 29 (32.2%) showed reactive changes. This correlates well with study performed by Rehman MZ and Islam S in which 10.32 % of malignant cases showed metastatic lymph nodes on FNAC. However, certain other studies have showed higher percentage of metastatic lymph nodes in malignant cases.[15,16] This might be due to the limited sample size in our study.
Among the benign conditions' Fibroadenoma and benign breast disease were the commonest diagnosis accounting for 184(35.9%) and 79(15.4%) respectively. Maximum incidence of fibroadenoma was found in age group of 21-30 years (87 cases).
Fibrocystic disease accounted for 48 cases (9.2%). Other benign and cystic lesions encountered were simple benign cysts (18=3.5%), galactocele (1.34%) and benign phyllodes (2=0.4%). In simple cysts, the cyst disappeared on aspiration and a reaspiration was then performed to look for any residual component. Galactocele showed milky fluid and presence of histiocytes. These findings are in accordance with other studies, which showed similar results [1,2,4,5,9,11,12,13,14]
Inflammatory lesions accounted for 65 cases (12.7%), which included 40 cases of abscess, 20 cases of granulomatous mastitis and 05 cases of chronic mastitis. All 20 cases of granulomatous mastitis were non-caseating and ZN stain for acid-fast bacilli (AFB) was negative. This could be due to the fact that tuberculosis of breast is a relatively rare lesion and not very commonly encountered.
Other cases (10=1.95%) included those of duct ectasia, gynaecomastia and cases in which repeated aspirates yielded only fatty tissue and hence no opinion was possible.
CONCLUSION: FNAC is a relatively simple procedure with good patient acceptance and low morbidity. It is an accurate, safe and repeatable procedure in the diagnosis of various breast lesions both malignant and non-malignant. Repeated passes should be made for a greater yield of cytological material. FNAC should be used earlier and more frequently to shorten the diagnostic interval and allow more prompt therapy for malignant breast lesions.
[1.] Rahman MZ, Islam S. Fine Needle Aspiration Cytology of Palpable Breast Lump: A Study of 1778 Cases. Surgery 2013 S12: 001. doi: 10.4172/2161-1076. S12-001.
[2.] Singh A, Haritwal A, Murali B. Pattern Of Breast Lumps And Diagnostic Accuracy Of Fine Needle Aspiration Cytology; A Hospital Based Study From Pondicherry, India. The Internet Journal of Pathology 2010; 11(2): 1-11.
[3.] Khemka A, Chakrabarti N, Shah S, Patel V. Palpable Breast Lumps: Fine-Needle Aspiration Cytology versus Histopathology: a Correlation of Diagnostic Accuracy. The Internet journal of Surgery 2008; 18(1): 1-21.
[4.] Aslam S, Hameed S, Afzal T, Hussain A. Correlation of FNAC and Histological Diagnosis in the Evaluation of Breast Lumps. JUMDC 2012; 3(2): 1-7.
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Manas Madan (1), Manisha Sharma (2), Rahul Mannan (3), Mridu Manjari (4) Jasmeet Kaur (5), Saumil Garg (6)
(1.) Manas Madan
(2.) Manisha Sharma
(3.) Rahul Mannan
(4.) Mridu Manjari
(5.) Jasmeet Kaur
(6.) Saumil Garg
PARTICULARS OF CONTRIBUTORS:
(1.) Associate Professor, Department of Pathology, SGRDIMSAR, Amritsar, India.
(2.) Associate Professor, Department of Pathology, SGRDIMSAR, Amritsar, India.
(3.) Associate Professor, Department of Pathology, SGRDIMSAR, Amritsar, India.
(4.) Professor & HOD, Department of Pathology, SGRDIMSAR, Amritsar, India.
FINANCIAL OR OTHER COMPETING INTERESTS: None
(5.) Junior Resident, Department of Pathology, SGRDIMSAR, Amritsar, India.
(6.) Junior Resident, Department of Pathology, SGRDIMSAR, Amritsar, India.
NAME ADDRESS EMAIL ID OF THE CORRESPONDING AUTHOR:
Dr. Manas Madan, # 21-A, Sandhya Enclave, Majitha Road, Amritsar.
Date of Submission: 05/06/2015.
Date of Peer Review: 06/06/2015.
Date of Acceptance: 01/07/2015.
Date of Publishing: 07/07/2015.
Table 1: Cytological Typing all breast lesions. Lesion Diagnosis Total Inflammatory Abscess 40 65 Chronic mastitis 05 Granulomatous mastitis 20 Cystic Benign simple cysts 18 73 Fibrocystic 48 Galactocele 07 Benign Fibroadenoma 184 265 Benign phyllodes 02 Benign breast disease 79 Atypical ADH/DCIS 04 09 Suspicious of malignancy 05 Malignancy IDC 88 90 Mucinous 02 Others Duct ectasia, Gynaecomastia, 10 10 Fatty aspirates Total 512 Table 2: Axillary lymph node status in malignant cases Lymph node No. of cases % Metastatic 09 10.00 Reactive 29 32.22 Not palpable 52 57.78 TOTAL 90 100.00
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|Title Annotation:||ORIGINAL ARTICLE|
|Author:||Madan, Manas; Sharma, Manisha; Mannan, Rahul; Manjari, Mridu; Kaur, Jasmeet; Garg, Saumil|
|Publication:||Journal of Evolution of Medical and Dental Sciences|
|Date:||Jul 9, 2015|
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