Evaluation of Fine needle aspiration cytology in the diagnosis of suspicious/gray zone lesions in breast lesions and its histopathological correlation
Keywords:
FNAC, Malignant, Breast, Histopathology
Abstract
Introduction: Fine needle aspiration cytology (FNAC) is an established tool in the diagnosis of palpable lesions. FNAC is a sensitive and rapid method in differentiating benign breast lesions from malignant ones. But there exist some gray areas in which this differentiation becomes difficult. Problem arises in categories C3 and C4 in which there exists significant interobserver variation in the diagnosis. The study was done to evaluate the usefulness of FNAC in diagnosis of C3 and C4 categories and correlate it with histopathological diagnosis.Methods: This Study was conducted on 512 cases of breast FNAC in from January 2014 to December 2014. FNAC diagnosis of C3 and C4 categories were selected. The cytological diagnosis was compared with histopathological diagnosis in the cases where biopsy was done subsequent to FNAC diagnosis.Results: C3 and C4 categories constituted 28 (5.46%) and 48 (9.3%) cases respectively. Histopathology was available in 13 cases of C3 (46.4%) and 30 cases of C4 (62.5%). Among C3 category, 10/13 cases showed benign lesions (77%) and 3/13 cases were malignant (23%). Among C4 category, 4/30 cases showed benign lesion (13.3%) and 26/30 cases were malignant (86.7%). There was a significant statistical difference between benign and malignant diagnosis of C3 & C4 categories (p< 0.001).Conclusion: Clinicians and pathologists should understand the limitations of FNAC. C3 and C4 categories should still be continued with, as there was a statistically significant difference in benign & malignant diagnosis for these categories in our study.References
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13. Omi Y, Yamamoyo T, Okamoto T, Nishikawa T, Shibata N. Fine needle aspiration versus core needle biopsy in the diagnosis of the intraductal breast papillary lesions. World Journal of Pathology. 2013;2:11.
2. Shabb NS, Boulos FI, Abdul-Karim FW. Indeterminate and erroneous fine-needle aspirates of breast with focus on the 'true gray zone': a review. Acta Cytol. 2013;57(4):316-31.
3. Chaiwun B, Sukhamwang N, Lekawanvijit S, Sukapan K, Rangdaeng S, Muttarak M et al. Atypical and suspicious categories in fine needle aspiration cytology of the breast: histological and mammographical correlation and clinical significance. Singapore Med J. 2005;46(12):706-9.
4. Mitra S, Dey P. Grey zone lesions of breast: potential areas of error in cytology. J Cytol. 2015;32:145-52.
5. Goyal P, Sehgal S, Ghosh S, Aggarwal D, Shukla P, Kumar A et al. Histopathological correlation of Atypica; (C3) and Suspicious (C4) categories in Fine Needle Aspiration Cytology of the breast. Int J Breast Cancer. 2013;2013: 965498.
6. Yu YH, Wei W, Liu JL. Diagnostic value of fine-needle aspiration biopsy for breast mass: a systematic review and meta-analysis. BMC Cancer. 2012;25:12-41.
7. Kanhough R, Jorda M, Gomez-Fernandez C, Wang H, Mirzabeigi M, Ghorab Z, et al. Atypical and suspicious diagnoses in breast aspiration cytology-is there a need for two categories? Cancer. 2004;102:164-7.
8. Howell LP. Equivocal diagnoses in breast aspiration biopsy cytology: Sources of uncertainty and the role of “atypical/indeterminate” terminology. Diagn Cytopathol. 1999;21:217-22.
9. Deb RA, Matthews P, Elston CW, Ellis IO, Pinder SE. An audit of “equivocal” (C3) and “suspicious” (C4) categories in fine needle aspiration cytology of the breast. Cytopathology. 2001;12:219-26.
10. Lim JC, Al-Masri H, Salhadar A, Xie HB, Gabram S, Wojcik EM. The significance of the diagnosis of atypia in breast fine-needle aspiration. Diagn Cytopathol. 2004;31:285-8.
11. Yusuf I, Atanda AT, Imam MI. Cyto-morphologic correlationof equivocal C3 and C4 breast lesions. Arch Int Surg. 2014;4:131-5.
12. Tikku G, UMAP P. Comparative Study of Core Needle Biopsy and Fine Needle Aspiration Cytology in Palpable Breast Lumps: Scenario in Developing Nations. Turk Patoloji Derg. 2016;32:1-7.
13. Omi Y, Yamamoyo T, Okamoto T, Nishikawa T, Shibata N. Fine needle aspiration versus core needle biopsy in the diagnosis of the intraductal breast papillary lesions. World Journal of Pathology. 2013;2:11.
Published
2016-12-15
Section
Original Article
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