S.H. Shah ( Department of Pathology, The Aga Khan University Hospital, Karachi. )
N. Kayani ( Department of Pathology, The Aga Khan University Hospital, Karachi. )
S.H. Hasan ( Department of Pathology, The Aga Khan University Hospital, Karachi. )
I.N. Soomro ( Department of Pathology, The Aga Khan University Hospital, Karachi. )
S. Pervez ( Department of Pathology, The Aga Khan University Hospital, Karachi. )
A.S. Hussainy ( Department of Pathology, The Aga Khan University Hospital, Karachi. )
A total of 113 fine needle aspirates of the breast masses were evaluated in which the subsequent biopsy or mastectomy specimen were also available for histological examination. The age ranged from 16 to 80 years with a mean of 42 years. In benign conditions the mean age was 34.7 years while in malignant cases it was 48 years. The cytological diagnoses were compared with the histological results which revealed that the specificity and sensitivity of fine needle aspiration cytology in the palpable breast lesions was 86.1% and 89.2% respectively with a positive predictive value of 93% and efficiency of 88.2%. Similar statistics from other series in which the cytological results of breast lesions were compared with histological results, revealed almost same results which suggest that fine needle aspiration cytology is an effective and accurate technique for the diagnosis and management of palpable breast lumps (JPMA 48:7,1998).
Cytological examination of fine needle aspirates of the palpable breast lesions has become a widely used adjuvant diagnostic technique in the management of breast lumps1,3. Fine needle aspiration is a simple procedure requiring no special instruments and providing rapid interpretation with a high degree of diagnostic accuracy reported from 76% to 96%1,2,4-6. Due to simplicity, accuracy, cost effectiveness and less chances of complications, the fine needle aspiration is well tolerated by the patients and in many instances, it has replaced open biopsy and frozen sections. The present study was carried out in the department of pathology, the AgaKhan University Hospital, Karachi, to evaluate the diagnostic accuracy of fine needle aspiration cytology in palpable breast lesions by comparing its results with histological diagnoses of the subsequent openbiopsy or mastectomy specimens ofthese patients.
Materials and Method
The fme needle aspirations performed at the clinical laboratoiy of the Aga Khan University Hospital in the period Januaiy to October, 1996 were included in the study in which the subsequent open biopsy or mastectomy specimens were received for histological diagnosis. The fine needle aspirations were done according to the standard methods by using a 21 gauge needle and 10 ml disposable syringe. Two to four slides were made from the aspirates and wet fixed with 95% ethanol. The smears were stained with heamatoxylin and eosin and papanicolaou stains. The rest of the material was submitted for cell block preparation. After thorough examination of the smears the cases were grouped into four major diagnostic categories.
1. Positive for malignant cells.
2. Atypical or suspicious of malignancy.
4. Unsatisfactory material or inadequate for proper inteipietation.
The aspirates were declared adequate/satisfactoiy when cytological examination revealed more than four to six well visualized cell groups. Each group could be a cluster of more than six cells or a sheet of more than ten cells. The results of cytological diagnosis of these patients were compared with the histological diagnosis of the subsequent tissue specimens i.e. open biopsy or mastectomy received within a period of six months. The statistical methods of Galen and Gambino were employed for the calculation of sensitivity, specificity, positive predictive value and efficiency8.
A total of 113 fine needle aspirates were evaluated in which the subsequent histological diagnosis were available for comparison. Results of cytological diagnosis are shown in Table 1.
The comparison between cytological and subsequent histological diagnoses revealed that 41(100%) cases were diagnosed to be malignant both on cytology and histology. Of the 30 cases, reported as suspected malignancy, the histological examination confirmed it in 25 (83.3%) specimens, while five were benign. Of the 37 specimens labelled benign on cytology, subsequent histology proved six (16.2%) to be malignant. The sensitivity and specificity of fine needle aspiration cytology was calculated to be 89.2% and 86.1% with positive predictive value of 93% and efficiency of 88.2%. All the patients were females. The age ranged from 24 to 80 years with mean of 42.3 years in malignant cases while in benign conditions the age varied from 16 to 65 years with mean of 34.8 yeats. The tumour size was 1.5 cms to 11 cms with average of 4.1 cms. None of the patients developed any complication during the procedure.
The fine needle aspiration cytology has achieved great importance in the diagnosis and management of palpable breast lesions. Due to simplicity, safety and diagnostic accuracy this procedure has replaced open biopsy and frozen sections.7,9 In clinical practice, breast lesions are one of the important and common medical problems of the female population, with breast carcinoma bein# the most common malignant tumour especially in females10-13 Inthe presented study, there was no discrepancy in the diagnosis of the 41 malignant cases between cytology and histology. Of the thirty cases suspected of malignancy, twenty five (83.3%) were confirmed on histological examination. All had focally atypical cells and frozen section/open biopsy was recommended. The benign cases were fibroadenoma, phyllodes tumour, duct ectasia, papillomatosis and fibrocystic disease. Occasionally, increased cellularity, loss of cohesion and nuclear atypia in the aspirates from intraductal papilloma14, fibroadenoma and fibrocystic disease15,16 may lead to erroneous interpretation. Of the thirty-seven cases diagnosed benign on cytology, six were proved malignant on histological examination. These included three infiltrating ductal carcinomas, two infiltrating lobular carcinomas and one papillary carcinoma. In all these cases the tumour size was less than 2 cms. False negative results could be found in monomorphic, well differentiated carcinomas, lobular carcinomas and sclerotic carcinomas6. Inthe present study the sensitivity and specificity of fme needle aspiration cytology was 89.2% and 86.1% respectively with positive predictive value of 93% and efficiency of 88.2%. The results were compared with the other series (Table II).
This revealed consistency of performance among various institutions with respect to fine needle aspiration cytology of breast lesions. It was concluded by the study that fine needle aspiration cytology is a good diagnostic technique for palpable breast lesions. However, in clinically or cytologically suspicious cases, a repeat fine needle aspiration, frozen -section or excision biopsy should be performed.
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