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ROLE OF FINE NEEDLE ASPIRATION CYTOLOGY IN BREAST LESIONS.

BACKGROUND

Breast is a dynamic organ which undergoes cyclical changes under the influence of hormone and growth factors acting on the epithelial and stromal tissue throughout the reproductive life of a woman. [1] Various breast lesion are common in females with a wide range of variability from inflammatory lesions, benign and malignant breast lesions. [2] Breast lumps are common complaints of women visiting health organisation clinics, of which 80 to 85% are benign and rest are malignant. [3-5] Breast cancer is the leading cause of morbidity and mortality in women. [6] By 2020 breast cancer is set to overtake cervical cancer as the most common type of cancer among all women in India. [7]

Fine needle aspiration cytology has become widely accepted as simple and cost effective diagnostic tool with high sensitivity and specificity. [8]

The sensitivity and specificity of Fine needle aspiration cytology (FNAC) as a diagnostic tool for palpable breast lumps are 65-99% and 96-100% respectively. [9] Fine needle aspiration cytology (FNAC) is widely accepted as a reliable technique in the initial evaluation of palpable and non-palpable (guided biopsy) breast lumps. The procedure is simple, safe, cost effective, minimally invasive, rapid and as sensitive as biopsy. [10] This study was conducted to study the spectrum of both benign and malignant lesions of breast, to study the cytomorphological features of various breast lesions by FNAC, to see the incidence and categorisation of lesion on basis of five tier system.

Aims and Objectives

1. To study the spectrum of both benign and malignant lesions of breast by FNAC.

2. To study the cytomorphological features of various breast lesions by FNAC.

3. To study the incidence of various breast lesions.

4. Categorisation of breast lesion on basis of five tier system.

MATERIALS AND METHODS

Study Design---A cross-sectional study.

Study Period--July 2016 to June 2017.

Study Place

Department of Pathology, Saraswathi Institute of Medical Sciences, Anwarpur, Pilkhuwa, Hapur, U. P.

Study Population

100 cases.

Inclusion Criteria

1. All the new cases of palpable breast mass sent for FNAC to the pathology department.

2. Includes both males and females.

Sample Size

Patients fulfilling all inclusion and exclusion criteria were enrolled in the study. A written informed consent was obtained from all the subjects before their enrolment in study.

A detailed clinical history was taken with special reference to menstrual age at marriage, age at first delivery, parity and habit of breast feeding, pain in breast and discharge from nipple. An inquiry was made regarding the use of oral contraceptive, dietary history, history of injury and radiation to the breast region and family history of tumours. A complete local and general examination including size of the breast and size of the lump. Consistency of lump, tenderness, fluctuation in the lump, fixity of the lump to skin or chest wall, any previous operative mark, any ulcerated area over the skin of breast and the presence of axillary lymph nodes was carried out in all 100 patients.

Fine needle aspiration cytology (FNAC) was performed on enrolled patients by the Pathologist. The staining methods used were Giemsa Stain, Haematoxylin and Eosin stain.

Statistical Analysis

All data was collected and verified. Collected data was subjected to SPSS (version 20) for analysis. Results were statistically evaluated by applying Chi-square test. P value of 0.05 was considered significant.

RESULTS

The most common affected age group was 21 to 40 years having 60% patients. FNAC results were divided according to the spectrum of lesions on cytomorphological interpretation and diagnosis into benign (61 cases), inflammatory (22 cases) and malignant (12 cases), atypical/ probably benign (3 cases) and no definite opinion (2 cases). In 12 malignant lesions maximum cases, that is 10 cases were of ductal carcinoma and only 2 were diagnosed as mucinous carcinoma. Categorisation of breast lesion on the basis of 5 tier system was done in which 2 cases were of C1, 65 cases of C2, 18 cases of C3, 3 cases of C4 and 12 cases of C5.

Out of 100 patients, 9 were males and 91 were females.

Benign fibroadenoma was most commonly seen (in 31 patients) followed by benign epithelial hyperplasia (17 patients), inflammatory acute mastitis (10 patients), malignant--ductal (10 cases), benign fibrocystic lesion (9 cases).

Categorisation of breast lesion on the basis of 5 tier system was done in which 2 cases were of C1, 65 cases of C2, 18 cases of C3, 3 cases of C4 and 12 cases of C5.

Fibroadenoma is the commonest condition in the benign category followed by benign epithelial hyperplasia.

Acute mastitis/ abscess is most common in inflammatory category followed by tubercular mastitis.

Statistically significant association is seen between age and breast lesions (p value less than 0.05).

Here, p < .05 statistically significant association was found between type of lesions vs. site.

DISCUSSION

The primary goal of FNA is to separate benign and malignant lesions, so that early diagnosis helps in management and reduces morbidity and mortality. Breast diseases are more common in women because oestrogen cyclically stimulates breast during their reproductive life. [11]

The most common affected age group was 21 to 40 years, having 60% patients followed by 41 to 60 years having 20% patients. Similar age groups were observed by Chandanwale et al, [12] Likhar et al, [13] Farkhanda et al and Godwins E et al. [14] Haque et al [15] have reported 30-40 years' age group as the most common age group in their study.

In our study, majority 55% of the patients with benign breast disease were in the age group of 21-40 and these findings are consistent with those of similar studies from Karki et al, [16] Guray et al, [17] Houssami et al, [18] Dahri et al and Naveen et al. [19]

FNAC results were divided according to the spectrum of lesions on cytomorphological interpretation and diagnosis into benign (61 cases), inflammatory (22 cases) and malignant (12 cases), atypical/ probably benign (3 cases) and no definite opinion (2 cases). In our study, benign lesions were maximum. They were 7 times more common than malignant lesions. Kumar et al [20] also reported the same. Adesunkanmi et al [21] have reported 87.2% of benign lesions and Chandanwale et al [12] have reported 80% of benign lesions.

The most common lesion in this study was fibroadenoma constituting 31% of the total cases. In the present study maximum cases of fibroadenoma were in the age group of 21-30 years, which is similar to results shown by Kochhar et al, [22] Khanzada et al, [23] Iyer et al, [24] Akhator et al, [25] Irabor et al [26] and Naveen et al. [19]

The number of malignant lesions in the present study were found to be twelve, which is in concordance with Park et al, [27] Rocha et al [28] and Dominguez et al. [29] Maximum number of malignant cases were found in 41 to 60 years of age group, which is similar to the results by Khan et al. In the 12 malignant lesions, maximum cases that is 10 cases were of ductal carcinoma and only 2 were diagnosed as mucinous carcinoma. Singh et al [30] reported that ductal carcinoma is the most common breast malignancy and was found in the age group of 41-60 years. The present study showed similar results. Mayun et al [31] reported 40% cases of malignancy in their study. In our study, malignancy was found to be less as we cater rural population. Mortality and incidence is relatively lower in developing countries and other parts of globe in comparison to western population. Khan et al [32] and Yeole et al [33] in an epidemiological study compared the breast cancer incidence of various countries and found that incidence rates were very high in developed countries. The incidence of breast cancer increases with age, more common in urban population and in women of higher socioeconomic group. They also suggested that apart from genetic causes, change in lifestyle is responsible for increase in incidence of malignant breast lesions.

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. Our study showed benign breast lesions are commoner than malignant lesions. Fibroadenoma is the commonest condition in the benign category followed by benign epithelial hyperplasia, whereas ductal carcinoma accounts for the highest number of malignant lesions.

The most common affected age group was 21 to 40 years having 60% patients. FNAC results were divided according to the spectrum of lesions on cytomorphological interpretation and diagnosis into benign (61 cases), inflammatory (22 cases) and malignant (12 cases), atypical/ probably benign (3 cases) and no definite opinion (2 cases). In 12 malignant lesions, maximum cases that is 10 cases were of ductal carcinoma and only 2 were diagnosed as mucinous carcinoma. There is statistically significant association seen between age and breast lesions and also between site and breast lesions. Categorisation of breast lesion on the basis of 5 tier system was done in which 2 cases were of C1, 65 cases of C2, 18 cases of C3, 3 cases of C4 and 12 cases of C5.

REFERENCES

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Atul Upadhyay (1), Surubhi Solanki (2), Sarandeep Singh Puri (3), Paramjit Singh Dhot (4), Parul Singhal (5)

(1) 3rd Year Postgraduate Student, Department of Pathology, SIMS, Hapur, Uttar Pradesh.

(2) Tutor, Department of Pathology, SIMS, Hapur, Uttar Pradesh.

(3) Assistant Professor, Department of Pathology, SIMS, Hapur, Uttar Pradesh.

(4) Professor and HOD, Department of Pathology, SIMS, Hapur, Uttar Pradesh.

(5) Professor, Department of Pathology, SIMS, Hapur, Uttar Pradesh.

'Financial or Other Competing Interest': None.

Submission 20-03-2018, Peer Review 18-04-2018, Acceptance 25-04-2018, Published 21-05-2018.

Corresponding Author:

Dr. Sarandeep Singh Puri, R-12/72, Raj Nagar, Ghazabad-201001, Uttar Pradesh.

E-mail: drsarandeep147@gmail.com

DOI: 10.14260/jemds/2018/573
Table 1. Gender distribution of Patients

Gender   Frequency   Percent

Female   91          91.0
Male     9           9.0
Total    100         100.0

Table 2. Spectrum of various Breast Lesions

Type of Lesions                       Frequency   %

Benign epithelial hyperplasia         17          17.0
Benign fibroadenoma                   31          31.0
Benign fibrocystic lesion             9           9.0
Benign gynaecomastia                  4           4.0
Inflammatory acute mastitis/abscess   10          10.0
Inflammatory granulomatous mastitis   4           4.0
Inflammatory fat necrosis             2           2.0
Inflammatory tubercular mastitis      6           6.0
Malignant--ductal                     10          10.0
Malignant--mucinous                   2           2.0
No definite opinion                   2           2.0
Suspicious for benign/ atypical       3           3.0
Total                                 100         100.0

Table 3. Categorisation of Breast Lesion on the basis of Five Tier
System

Cytological 5 Tier Grading System   Frequency   Percent

C1                                  2           2.0
C2                                  65          65.0
C3                                  18          18.0
C4                                  3           3.0
C5                                  12          12.0

Table 4. Cytomorphological Features of Benign Breast Lesion

Benign                   Frequency   Percent(%)

Epithelial hyperplasia   17          27.87
Fibroadenoma             31          50.82
Fibrocystic lesion       9           14.75
Gynaecomastia            4           6.56
Total                    61          100.0

Table 5. Cytomorphological Features of Inflammatory Breast Lesion

Inflammatory              Frequency   Percent (%)

Acute mastitis/ abscess   10          45.45
Granulomatous mastitis    4           18.18
Fat necrosis              2           9.09
Tubercular mastitis       6           27.27
Total                     22          100.0

Table 6. Cytomorphological Features of Malignant Breast Lesion

Malignant   Frequency   Percent(%)

Ductal      10          83.33
Mucinous    2           16.67
Total       12          100.0

Table 7. Association of Age with Breast Lesions

                  Age Group (in Years)         Total   Chi-     P
Type of Lesions   0-20   21-40   41-60   >60           Square   Value
                                                       Value

Benign            16     36      9       0     61      32.59    0.001
Inflammatory      2      17      3       0     22
Malignant         0      3       8       1     12
No definite       0      2       0       0     2
opinion
Suspicious for    1      2       0       0     3
benign/atypical
Total             19     60      20      1     100

Table 8. Association of Site with Breast Lesions

Type of        Site                                  Chi-     P
Lesions        Bilateral   Left     Right    Total   Square   Value
               Breasts     Breast   Breast           Value

Benign         3           36       22       61
Inflammatory   0           7        15       22
Malignant      0           2        10       12
No definite    0           2        0        2
opinion
Suspicious     0           0        3        3       18.81    0.016
for benign/
atypical
Total          3           47       50       100
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Title Annotation:Original Research Article
Author:Upadhyay, Atul; Solanki, Surubhi; Puri, Sarandeep Singh; Dhot, Paramjit Singh; Singhal, Parul
Publication:Journal of Evolution of Medical and Dental Sciences
Article Type:Report
Geographic Code:9INDI
Date:May 21, 2018
Words:2847
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