Introduction
Fine-needle aspiration (FNA) has become a important tool in the investigation of palpable breast masses.1
It is a less comp licated procedure with good results; however main factors should be considered before its procedure to increase its accuracy.2
All breast lesions are not malignant, and all the benign breast lesions do not proceed to malignancy. The diagnosis can be combined with preoperative tests like physical examination, mammography, fine-needle aspiration cytology and biopsy . These tests are more accurate and acceptable.3,4
Materials and methods
This study was carried out in a Mandya Institute of Medical Sciences, Mandya. This was a retrospective study between January 2018 and December 2018. The study was approved by institution ethics committee. All the patients presenting with breast lump were included in the study. The patients were counselled about the procedure, informed consent was taken. Detailed clinical history, physical examination including the duration, size, consistency and mobility were taken into consideration.
FNAC was performed using 22 G needles attached to 10cc syringe and the A spirated material was smeared on glass slides. Smears were fixed in 95% ethyl alcohol and stained with Hematoxylin and Eosin (Hand E) and Pap stains. Giemsa stain was done on air dried smears.
Results
Fine needle aspiration was done on Two hundred and fifty patients, Out of them 140(56%) were benign, 30(12%) cases were suspicious probably benign, 30(12%) cases were suspicious of malignany and 50(20%) were malignant.
Majority of patients were in the age group of 21-60 years. Blood mixed aspirate was most common.
Among benign cases, maximum were Fibroadenoma cases followed by Fibrocystic disease.
Ductal carcinoma in situ was most common type observed among malignant cases.
Benign cases were significantly more in younger age (less than 40 years) whereas malignant
breast lesions were found significantly more in older age group ( greater than 40 years).
Table 1
| Age in years | Benign lesions | Suspicious for malignancy | Malignant | |
| Inflammatory | Benign Proliferative lesions | |||
| 20- 30 | 15 | 50 | 5 | 5 |
| 30- 40 | 20 | 30 | 10 | 15 |
| 40- 50 | 10 | 20 | 10 | 15 |
| 50- 60 | 15 | 10 | 5 | 15 |
| Total | 60 | 110 | 30 | 50 |
Age of the patients presenting with lump breast
Table 2
| Inflammatory Lesions | Cytology |
| Acute suppurative Mastitis | 15(25%) |
| Acute mastitis | 20(33.33%) |
| Chronic nonspecific Mastitis | 15(25%) |
| Duct ectasia | 5(8.33%) |
| Fat necrosis | 5(8.33%) |
Distribution of inflammatory lesions
Table 3
| Benign Lesions | Cytology |
| Fibroadenomas | 65(59.09%) |
| Fibrocystic disease | 35(31.81%) |
| Benign phyllodes | 10(9.09%) |
Distribution of Benign proliferative lesions
All cases of Suspicious of Malignancy and Malignant lesions were diagnosed on FNAC as Infiltrating Ductal Carcinoma. In our study we didnt include Histopathological correlation. Our study was mainly concentrated on cytological smears of breast palpable lesions.
Discussion
The most common age group in our study was 21-60 years. Similar observations were reported by Farkhanda et al, Chandanwale et al, and Rajat Gupta et al.5,6,7 However Haque et al reported 30–40 years as most common age group.8
In present study, left breast and outer upper quadrant were more commonly involved as compared to right breast. Similar observations were made by Rajat Gupta et al.7
However Chandanwale et al reported more common involvement of right breast.6
Out of 250 cases of FNAC, 86% lesions were benign and 20 % were reported as malignant. This findings of our study correlates with Singh K et al and Khatun H et al.9,10
Bdour M et al had reported much higher incidence of carcinomas (41%).11
Benign lesions were significantly more associated with younger age groups as compared to malignant lesions which were more common in patients older than 40 years of age. Similar findings of our study correlates with Singh P et al, Khan A et al and Ageep AK.12,13,14
In present study, among benign lesions, fibro adenoma was most common benign lesion, followed by fibrocystic disease and ductal carcinoma was most common lesion among malignant ones which correlated with Singh K et al, Khatun H et al and Singh A et al.9,10,15
Studies done by Ageep AK and Memon A et al have reported fibrocystic disease as the common diagnosis followed by fibroadenoma.14,16 which shows little correlation with our studies.
We diagnosed 10 cases of benign phyllodes in our study. In 6 cases definitive diagnosis was given based on predominance of stromal components over epithelial, fragments of highly cellular myxoid stroma and numerous single spindle shaped bare nuclei. Nuclear atypia and mitotic figures were absent. In 4 cases, cytomorphologic features were similar to fibroadenoma showing more cellularity based on strong clinical suspicion of larger size, diagnosis was suggested. Our study was showing some similarities with study done by Krishnamurthy S et al.17
In our study out of 80 suspicious of malignancy and malignancy, all the diagnosis were given as infiltrating ductal carcinoma without specifying the subtype of carcinomas which was important for diagnosis and treatment of specific subtypes. Similar study was done on pitfalls of missing subtypes of breast carcinoma on FNA smears by Anantharamaiah H et al.18
Conclusion
The cytological examination of breast lesions is a rapid, economical valuable diagnostic tool, simple, safe and cost effective outpatient procedure. Early diagnosis can significantly reduce morbidity and mortality. Benign breast lesions constitute majority of breast masses occur in second and third decade.
Clinical breast examination and mammography screening should be encouraged in females from the third decade onwards for early detection of breast carcinoma. FNA features are more informative when combined with physical and radiology features.
