Phirthangmoi Fimate - Apr-6-Ori
Phirthangmoi Fimate - Apr-6-Ori
Phirthangmoi Fimate - Apr-6-Ori
1Department of Pathology, Jawaharlal Nehru Institute of Medical Sciences (JNIMS), Imphal, Manipur, India.
ABSTRACT
BACKGROUND
Breast lesions remain a major public health problem worldwide. Fine needle Corresponding Author:
aspiration cytology (FNAC) has become one of the first-line investigations for the Dr. Phirthangmoi Fimate,
Ebenezer Villa,
diagnosis of breast lumps. Although one of the major goals of FNAC is to
Near Shija Hospital,
differentiate benign from malignant lesions, in certain cases, this may not possible Langol, Imphal West-795004,
due to a lack of uniformity with regards to the reporting terminology used in breast Manipur, India.
cytology by pathologists worldwide, resulting in poor communication of results E-mail: [email protected]
among health-care providers. The present study aims to evaluate the role and
diagnostic accuracy of FNAC in the evaluation of breast lesions using the National DOI: 10.14260/jemds/2020/246
Cancer Institute (NCI) recommended terminology by correlating with
histopathological examination (HPE) results. Financial or Other Competing Interests:
None.
CONCLUSIONS
Our study concluded that FNAC is a rapid and effective method, and reporting of
smears using NCI guidelines highly correlated with the histopathological diagnosis.
KEY WORDS
Breast Lesions, Cytodiagnosis, Histopathologic Diagnosis, Fine-Needle Aspiration
Cytology, Histopathological Examination, National Cancer Institute
J. Evolution Med. Dent. Sci./eISSN- 2278-4802, pISSN- 2278-4748/ Vol. 9/ Issue 14/ Apr. 06, 2020 Page 1135
Jemds.com Original Research Article
J. Evolution Med. Dent. Sci./eISSN- 2278-4802, pISSN- 2278-4748/ Vol. 9/ Issue 14/ Apr. 06, 2020 Page 1136
Jemds.com Original Research Article
reports and codes for correlation. Patients with C2 and C3 C2 C3 C4 C5
Suspicious
Malignant
Atypical
Granulo
Lacta.
FAsis
taken as true negative, while those confirmed as malignant on Age Total %
Abs.
FCD
Gal.
FA
HPE were considered as false negative. Patients with C4 and
C5 diagnoses by FNAC but confirmed as benign on HPE were 11-20 46 2 2 0 0 1 1 0 0 0 52 13.6
considered as false positive, while those confirmed as 21-30 73 20 7 14 1 3 1 5 0 2 126 33.0
31-40 29 17 8 14 1 0 0 12 2 20 103 27.0
malignant were considered true positive. 41-50 11 8 5 21 0 0 0 4 1 22 72 18.8
51-60 2 0 1 2 0 0 0 1 1 17 24 6.3
61-70 0 0 0 0 0 0 0 0 0 4 4 1.0
71-80 0 0 0 0 0 0 0 0 0 1 1 0.3
Total 161 47 23 51 2 4 2 22 4 66 382 100.0
Statistical Analysis % 42.1 12.3 6.0 13.4 0.5 1.0 0.5 5.8 1.0 17.3 100.0
All the statistical analysis was performed using Statistical FA-Fibroadenoma, FAsis-Fibroadenosis, Abs-Abscess, FCD-Fibrocystic disease, Gal-
Galactocele, Lacta-Lactational change, Granulo-Granulomatous lesion
Package for Social Sciences Statistics (SPSS) version 20. The
Table 1. Age Distribution of Female Breast Lesions
sensitivity, specificity, positive predictive value (PPV), and
negative predictive value (NPV) along with 95% confidence Quadrant
Laterality UO UI LO LI Total %
interval (95% CI), accuracy, false positive rate, and false Right 152 (39.8%) 34 (8.9%) 18 (4.7%) 9 (2.4%) 213 55.8%
Left 111 (29.1%) 33(8.6%) 16 (4.2%) 9 (2.4%) 169 44.2%
negative rate of FNAC for diagnosing malignant breast lesions Total 263 67 34 18 382 100 %
were calculated. Qualitative data are summarized using % 68.8% 17.5% 8.9% 4.7%
UO-Upper outer, UI-Upper inner, LO-Lower outer, LI-Lower inner
frequency and percentage.
Table 2. Laterality and Quadrant
HPE
Benign Malignant
RESULTS
Cyt Diag
IDC-NOS
Granulo
IDC-Pap
MED CA
MUC CA
C
Total
Fasis
FCD
Abs
ILC
FA
There was a total of 382 cases of female breast FNAC’s during
the period of January 2011 to December 2012. Satisfactory FA 74 0 73 0 0 0 0 0 1 0 0
Abs. 5 5 0 0 0 0 0 0 0 0 0
aspirates were obtained in all of the cases. The age at Granulo 1 0 0 0 0 1 0 0 0 0 0
Fasis 2 0 0 2 0 0 0 0 0 0 0
presentation ranged from 14 to 75 years with a mean age of 2
FCD 23 0 0 0 23 0 0 0 0 0 0
34 years with SD of 11.8 years. Benign lesions were more 3 Atypical 7 0 2 0 3 0 1 1 0 0 0
4 Suspicious 1 0 0 0 0 0 1 0 0 0 0
common in 21–30 years and malignant lesions in 41–50 years 5 Malignant 43 0 0 0 0 0 41 0 0 1 1
(Table 1). All of the female patients presented with a Total 156 5 75 2 26 1 43 1 1 1 1
% 3.2 48.2 1.3 16.7 0.6 27.6 0.6 0.6 0.6 0.6
unilateral breast lump. The right breast (213, 55.8%) and the CytDiag-Cytologic Diagnosis, HPE-Histopathologic Examination, FA-Fibroadenoma,
upper outer quadrant (263, 68.8%) were most commonly Abs-Abscess, Fasis-Fibroadenosis, FCD-Fibrocystic disease, Granulo-Granulomatous
mastitis, IDC-Infiltrating duct carcinoma, NOS-Not otherwise specified, Pap-
involved. (Table 2). Among the 382 female breast FNAC cases, Papillary, ILC-Infiltrating lobular carcinoma, Med Ca-Medullary carcinoma, Muc Ca-
Mucinous carcinoma.
there were no category C1 cases (all satisfactory smears), C2
Table 3. Comparison of Cytology with Histopathology Reports
consisted of 290 (75.8%), C3 consisted of 22 (5.8%), C4
consisted of 4 (1%), and C5 consisted of 66 (17.3%) cases.
Unsatisfactory
C2 (%) Benign
Malignant
Atypical
Number
of Cases
Year of
C1 (%)
C3 (%)
C4 (%)
C5 (%)
Study
Study
HPE, 99% (104/105) cases of C2 were confirmed as benign Singh et al15 2014 100 5 (5) 51 (51) 2 (2) 3 (3) 39 (39)
Arul and
2015 523 14 (2.7) 352 (67.3) 27 (5.2) 41 (7.8) 89 (17)
and the remaining 1 case turned out to be malignant Masilamani1
Madubogwu
(infiltrating lobular carcinoma, ILC). In C3, benign lesions et al 10
2017 110 17 46 5 4 38
were confirmed in 71.4% (5/7) and the remaining two cases Veena et al 16 2017 178 4 (2.2) 134 (75.28) 14 (7.8) 6 (3.3) 20 (11.2)
Present study 2019 382 0 290 (75.8) 22 (5.8) 4 (1.0) 66 (17.3)
(28.6%) were diagnosed to be malignant. In both C4 and C5, Table 4. Comparison of the Distribution of Various National Cancer
all the cases were correctly cytodiagnosed as malignant with Institute Guidelines Comparison of Present Study with Published Studies
a cyto-histological concordance of 100% (45/45). The most
Year of No. of Benign No. of Malignant
common malignant lesion noted in C5 on HPE was invasive Study
Study Cases (%) Cases (%)
Total
ductal carcinoma-not otherwise specified (IDC-NOS, 43/47, Ukah and Oluwasola12 2005 126 (50.4) 124 (49.6) 250
Nguansangiam et al17 2006 102 (56) 80 (44) 182
91.5%). (Table 3) Sankaye and Dongre2 2012 31 (40.8) 45 (59.2) 76
The present study showed a sensitivity of 93.62% (95% Yusuf and Atanda18 2012 117 (58.5) 83 (41.5) 200
Arul and Masilamani1 2015 198 (69.2) 88 (30.8) 286
CI, 82.46%–98.66%), specificity of 100% (95% CI, 96.67%– Daramola et al6 2015 398 (91.3) 38 (8.7) 436
100%), PPV of 100% (95% CI, 92.5%–99.6%), NPV of 97.32% Madubogwu et al 10 2017 58 (52.7) 52 (47.3) 110
Veena et al 16 2017 112 (78.9) 30 (21.1) 142
(95% CI, 92.4%–99.09%), and accuracy of 98.08% for FNAC Present study 2019 109 (70) 47 (30) 156
in the diagnosis of malignant lesions. The false positive and Table 5. Comparison of Histopathological Cases
false negative rate was 0% and 6.4%, respectively. of the Present Study with Published Studies
J. Evolution Med. Dent. Sci./eISSN- 2278-4802, pISSN- 2278-4748/ Vol. 9/ Issue 14/ Apr. 06, 2020 Page 1137
Jemds.com Original Research Article
results. Factors contributing to false negative results may
Sensitivity %
Specificity %
include the small size of the lesion, hypocellularity, and
Accuracy
(95% CI)
(95% CI)
(95% CI)
(95% CI)
Year of
NPV %
PPV %
Study
Study
inadequate sampling during aspiration, histological tumour
%
types such as low nuclear grade in ILC, and
well-differentiated intracystic papillary carcinoma. All cases
Sankaye and
Dongre2
2012 88.37 96.42 97.43 84.37 91.54 from C4 and C5 was diagnosed as malignant on HPE. These
Arul and
93.1 99 97.6 97 results were considered as true positive. Both false negative
2015 (88.2%– (96.8%– (92.5%- (94.9%– 97.20
Masilamani1
95%) 99.8%) 99.6%) 97.8%)
and false positive diagnoses can be reduced by good sampling
Madubogwu et al10 2017 90 95.50 94.70 91.30 92.90 technique, proper tumour localization, triple assessment, and
Veena et al16 2017 99.23 90.17 92.19 99.01
93.62 100 100 97.32 more importantly availing expert second opinions for
Present Study 2019 (82.46%– (96.67%– (92.5%– (92.4%– 98.08 doubtful cases.
98.66%) 100%) 99.6%) 99.09%)
The present study showed a sensitivity of 93.62% (95%
Table 6. Comparison of Statistical Analyses of FNAC
of the Present Study with Published Studies CI, 82.46%–98.66%), specificity of 100% (95% CI, 96.67%–
100%), PPV of 100% (95% CI, 92.5%–99.6%), NPV of 97.32%
(95% CI, 92.4%–99.09%), and accuracy of 98.08% for FNAC
in the diagnosis of malignant lesions, comparable to other
D I SC U S SI O N published studies as in Table 6.
J. Evolution Med. Dent. Sci./eISSN- 2278-4802, pISSN- 2278-4748/ Vol. 9/ Issue 14/ Apr. 06, 2020 Page 1138
Jemds.com Original Research Article
patients: lessons learned from fine needle aspiration sector hospital in India. Patholog Res Int
cytology. Asian Pac J Cancer Prev 2014;15(8):3411-3. 2013;2013:695024.
[9] Kumar CA, Kumar PA, Tarannum K, et al. Study of breast [14] Chokshi MH, Mehta NP. Cytological study of palpable
lesions in a tertiary care centre: a retrospective study. breast lumps (407 cases) with their histological
Med Phoenix: An Official Journal of NMC, Birgunj, Nepal correlation. Int J Med Sci Public Health 2014;3(2):181-5.
2017;2(1):48-51. [15] Singh P, Chaudhry M, Nauhria S, et al. Cytomorphological
[10] Madubogwu CI, Ukah CO, Anyanwu Snc, et al. Sub- patterns of breast lesions diagnosed on fine-needle
classification of breast masses by fine needle aspiration aspiration cytology in a tertiary care hospital. Int J Med
cytology. Eur J Breast Health 2017;13(4):194-9. Sci Public Health 2015;4(5):674-9.
[11] Tiwari M. Role of fine needle aspiration cytology in [16] Veena KL, Vani R, Jijiya BP, et al. Evaluation of breast
diagnosis of breast lumps. Kathmandu University lumps by fine needle aspiration cytology in correlation
Medical Journal 2007;5(2):215-7. with histopathology. J Cont Med A Dent 2017;5(1):63-7.
[12] Ukah CO, Oluwasola OA. The clinical effectiveness of fine [17] Nguansangiam S, Jesdapatarakul S, Tangjitgamol S.
needle aspiration biopsy in patients with palpable breast Accuracy of fine needle aspiration cytology from breast
lesions seen at the University College Hospital, Ibadan, masses in Thailand. Asian Pac J Cancer Prev
Nigeria: a 10-year retrospective study. J Cytol 2009;10(4):623-6.
2011;28(3):111-3. [18] Yusuf I, Atanda AT. Validity of fine needle aspiration
[13] Challa VR, Guru BGY, Rangappa P, et al. Cytological and cytology of the palpable breast lesions: a teaching
pathological correlation of FNAC in assessing breast hospital experience. Niger J Basic Clin Sci
lumps and axillary lymph node swellings in a public 2014;11(1):36-40.
J. Evolution Med. Dent. Sci./eISSN- 2278-4802, pISSN- 2278-4748/ Vol. 9/ Issue 14/ Apr. 06, 2020 Page 1139