Title: Diagnostic Accuracy of FNAC in Evaluation of Breast Lumps
Authors: Sumeera Farhath SK, K.Sravan Kumar, Rita Singh, V. Ashok Kumar
DOI: http://dx.doi.org/10.18535/jmscr/v4i2.31
Background and objectives: This study was conducted to compare the diagnostic accuracy of fine needle aspiration cytology (FNAC)in differentiating the benign and malignant lesions of palpable breast lump with histopathological correlation. Methods: This study was conducted at MNR MEDICAL COLLEGE AND HOSPITAL, Sangareddy , Telangana. The study included 50 patients who presented with palpable breast lumps to the surgical out-patient department. Thorough physical examination was done and the patients were subjected to fine needle aspiration cytology of the palpable breast lump. The cytological examination was classified as: Insufficient sample - C1, Benign - C2, Probably Benign - C3, Suspicious of malignancy - C4, Malignant - C5.All these patients were subjected to open/excision biopsy followed by histopathological examination. The diagnostic accuracy of the fine-needle aspiration was then compared with the gold standard histopathology. Results: Most of the cases were of benign pathology of which Fibroadenoma were most common (64%). It was seen that all the patients were female patients in the age group of 15-75 years. Majority of the lumps were found to be in the upper outer quadrant (46%). The sensitivity of fine needle aspiration cytology was found to be 83.33% , The specificity 100%, Positive predictive value 100% and Negative predictive value 97.77% . Conclusion: In patients with a palpable breast lump fine needle aspiration cytology can help to rule out a malignant lesion. This can hence afford as a cost –effective method in diagnosing breast lesions. Also due to its good tolerability and high diagnostic accuracy the patient need not be subjected to further evaluation which helps in the psychological well being of the patient. But, FNAC results when negative or suspicious should be correlated with clinical examination and imaging findings to prevent false positives and false negatives. A diagnosis suspicious for malignancy should be confirmed by open biopsy. Keywords- Breast cancer, Breast lumps, Cytology, Diagnostic accuracy, Fine needle aspiration cytology, Histopathology 1. Sainsburg RC. The breast. In:Rusell RCG, Williams NS, Bulsrode CJK. editors. Bailey and Love’s Short Practice of Surgery. 24th edition, Arnold,London;2004: p824-846. 2. Ibrar Ahmed, RashedNazir, M.Y.Chaudry, Saddia Kundi. Triple assessment of Breast lump. JCPSP 2007, vol.17(9):535-8 3. Donegan WL. Evaluation of a palpable breast mass. N Engl J Med 1992;327:937-42 4. Baum M. Carcinoma of the Breast. In-Recent advances in surgery, London. Churchill Livingston, 1984;241:58 5. Kirby I.Bland, Samuel W .Beenken, Edward M.CopelandIII. TheBreast.In-Schwartz’s Principles of Surgery, Charles F. Brunicardi, McGrawHill 2005, P.470,475-77 6. Babatunde A Ayoade, Adedayo O Tade, and Babatunde A Salami. Clinical Features and Pattern of Presentation of Breast Diseases in Surgical Outpatient Clinic of a Suburban Tertiary Hospital in South-West Nigeria .Niger J Surg. 2012 Jan-Jun; 18(1): 13–16. 7. Klein S. Evaluation of Palpable Breast Masses. Am FamPhys2005; 71(9):324-343. 8. Harold J.Burstein, Jay R. Harris, Monica Morrow. Malignant tumors of Breast. In-Devita, Hellman, Rosenerg’ scancer: Principles and Practice of oncology. Lippincott 2008,8th ed:P.1612 9. Lindholm K. Breast. In: Orell SR, Sterrett GF, Whitaker D, eds. Fine NeedleAspiration Cytology. 4th ed. India: Churchill Livingstone; 2005: p 165-226. 10. Ahmed I, Nazir R, Chaudhary MY, Kundi S. Triple assessment of breastLump; J Coll Physicians Surg Pak. 2007 Sep; 17(9):535-8. 11. Reinikainen HT, Rissanen TJ, Pilippo UK, Paivansalo MJ; Contribution of ultrasonography and fine-needle aspiration cytology to the differentialdiagnosis of palpable solid breast lesions. Acta Radio 1999 Jul;40(4):383-9 12. Philip J Drew, Lindsay W Turnbull, Sumohan Chatterjee, John Read, Peter J Carleton, et al. Prospective Comparison of Standard Triple Assessment and Dynamic Magnetic Resonance Imaging of the Breast for the Evaluation of Symptomatic Breast Lesions. Annals of Surgery1999; 230(5) :680-5 13. Al-Mulhim AS, Sultan M, Al-Mulhim FM, Al-Wehedy A, Ali M, Al-Suwaigh A, Al-Dhafiri S, Bavemen O. Accuracy of the triple test in thediagnosis of palpable breast masses in Saudi females. Ann Saudi Med 2003 May-Jul;23(3-4):158-61 14. J.R.C.Sainsbury,S.Nicholson,G.K.Needham,V.Wadehra,J.R Farndon.Natural history of benign breast lump. Br J Surg1988; 75 : 1080 –1082.Abstract
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