Cytology of breast-lesions

Introduction: Breast lesions are leading cause of morbidity and mortality in women worldwide. Fine Needle Aspiration (FNA) is an affordable, minimally invasive and rapid method. It is gaining importance as a preoperative procedure to distinguish benign and malignant breast lesions. Thus unnecessary invasive procedures can be avoided. This study is undertaken to explore utility and accuracy of FNA in various breast pathologies. Objectives: 1) To study cytology of various breast lesions, 2) To correlate cytological diagnosis with histopathological diagnosis wherever possible, 3) To study sensitivity, specificity and accuracy of FNA in breast lesions Materials and Methods: A two year prospective study was carried out from November 2017 to November 2019 at Department of Pathology, JJM Medical College – Davangere. This study included patients with breast lesions referred for FNA. FNA was done. Cytomorphological features were studied. Cytomorphological diagnosis was correlated with histopathological diagnosis wherever possible. Results: Out of 425 patients with suspected breast lesions, cyto-histo morphological correlation was possible in 331 cases. Cytology histology concordance was 94.4%. This study has sensitivity of 90.1%, specificity of 96.5% and accuracy of 94.1%. Conclusion: FNA is highly simple, safe and effective technique. It should be an essential component in preoperative diagnosis of breast lesions. © 2020 Published by Innovative Publication. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by/4.0/)


Introduction
Breast lesions are one of the commonest diagnostic problems to clinicians as well as pathologists. 1 FNA is a simple and cost effective method. It helps in giving timely diagnosis. 2 Apart from confirming clinical diagnosis, FNA -breast also helps in distinguishing benign and malignant lesions. 3 It plays a crucial role in management of patients who are unwilling or unfit for surgery. 4 2. Objectives 1. To study cytology of various breast lesions, 2. To correlate cytological diagnosis with histopathological diagnosis wherever possible,

Exclusion criteria
Un cooperative patients were excluded. Informed consent was taken from the patients for the procedure and for being a part of this study. FNAC was done using a 22 gauge needle. Smears were made and stained with H & E and Giemsa. Cytomorphologcal features were studied. Yokohama s ystem was applied for cytomorphological grading of breast lesions (Table 1). Yokohama system was framed by International Academy of Cytology and various experts in the field of breast cytology. It defines five categories for reporting cytology of breast lesions. These categories are stratified by their risk of malignancy. 5 Histopathological specimens were processed routinely. Paraffin sections were stained with H&E and examined. Histopathological diagnosis was made independently. Cytopathological diagnosis was correlated with Histopathological diagnosis wherever possible.
Results of this study were calculated by using methodology of Galen and Gambino.

Results
A total of 425 patients were cytologically diagnosed to have Breast Pathologies. The following observations were made.
Age group of patients referred for FNA ranged from 18 to 73 years. Most common age group was 31 to 40 years. In present study, 419 lesions (98.6%) occurred in females. Remaining 6 cases (1.4%) were males.
On applying 5 tier system of classification of breast lesions (Table 2), maximum number of cases belonged to C2 category followed by C5 category. Benign lesions constituted 268 cases (Table 3). Most common lesion in benign category was Fibroadenoma (Image 1 and 2) -151 cases. This was followed by fibrocystic disease -50 cases. 102 breast lesions belonged to malignant category (Table  4). Ductal Carcinoma ( Image 3 and 4) was most common -constituting 82 cases.

Discussion
FNA is considered one of the most reliable methods of diagnosing breast lesions. It is an outpatient procedure with minimal complications and very high diagnostic accuracy. 9 Yokohama system stratifies breast lesions into 5 categories and ensures high quality of reporting which can help in appropriate management of patient. 5  As per 5 tier system of classification, maximum cases were in C2 category -63.06%, followed by C5 category -24%. Results were compared with other studies (Table 6 ) depicting 5 tier system. Present study has 3.06 % insufficient aspirates. Percentage of aspirates in previous studies varied from 0.0% to 11.0 %. 2,6-8 Reasons for insufficient aspirates are deep seated lesions and lesions with irregular borders. Most common benign lesion in our study is fibroadenoma and commonest malignant lesion is Ductal Carcinoma. These results correlate with study conducted by Anand V et al 6 and Paramesh et al. 10 Our study has cytology histology concordance of 94.4%, which is very good when taking cost effectiveness, speed and simplicity of procedure into consideration. Similar results were obtained in study conducted by Anand V et al 6 (89.7%). Sensitivity, specificity and accuracy are 90.1%, 96.5% and 94.1% which proves the efficacy and reliability of FNA in the field of breast lesions.

Conclusion
FNA is a very important technique for preoperative evaluation of patients with breast lesions. 5 tier system of grading breast lesions aids cytopathologists in diagnostic clarity. It also helps surgeons in deciding further patient management.

Conflict and interest
None