Jebmh.

com Original Research Article

Correlation of Fine Needle Aspiration Cytology with Histopathology of

Malignant Breast Lesions in a Tertiary Care Hospital- Mandya
M. S. Siddegowda1, Tahniyat Ara2

1
Associate Professor, Department of Pathology, Mandya Institute of Medical Sciences, Mandya, Karnataka.
2
Consultant Pathologist, Department of Pathology, Gulbarga, Karnataka.

A BS T R A C T

BACKGROUND Corresponding Author:

Breast cancer is a common malignant lesion in women. Fine needle aspiration Dr. Tahniyat Ara,
cytology has high sensitivity and specificity and is a simple, rapid and safe method Consultant Pathologist,
Department of Pathology,
to diagnose breast lesions. The aim of the study was to evaluate malignant breast
H. No. 1-2-88, Sultanpur Lane,
lesions and correlate the fine needle aspiration cytology diagnosis with
Gulbarga- 585104, Karnataka.
histopathological findings. E-mail: tahniyat786@gmail.com
DOI: 10.18410/jebmh/2019/559
METHODS
This is a prospective study done in the Department of Pathology of Mandya Financial or Other Competing Interests:
Institute of Medical Sciences, Mandya. The study was conducted for a period of None.
1.5 years from January 2016 to June 2017. There was a total 200 FNAC cases.
Out of 200 cases of breast FNACs evaluated, histopathological correlations were How to Cite This Article:
available for 88 cases. Among 200 cases, two cases were inadequate for Siddegowda MS, Ara T. Correlation of
evaluation, 160 cases were benign, three cases were diagnosed as atypia probably fine needle aspiration cytology with
histopathology of malignant breast
benign, one case was diagnosed as suspicious of malignancy and 34 cases were
lesions in a tertiary care hospital,
diagnosed as malignant.
Mandya. J. Evid. Based Med. Healthc.
2019; 6(41), 2697-2701. DOI:
RESULTS 10.18410/jebmh/2019/559
Out of 34 malignant cases, majority of the cases were in the age group of 41 to
50 years followed by 31 to 40 years. Of the 34 malignant cases, 28 were reported Submission 20-09-2019,
as Infiltrating Ductal Carcinoma, Not Otherwise Specified (NOS) type, three cases Peer Review 27-09-2019,
were reported as mucinous carcinoma breast on cytology, one case was reported Acceptance 06-10-2019,
Published 11-10-2019.
as medullary carcinoma breast, one case was reported as papillary carcinoma
breast and one case was reported as metaplastic carcinoma breast on cytology.
Among these 34 cases, 27 cases were available for histopathological correlation
which proved to be malignant on histopathology also. FNAC proved to be 100%
sensitive and specific in the diagnosis of malignant lesions.

CONCLUSIONS
Fine needle aspiration cytology is a highly sensitive and specific technique for
diagnosis of malignant breast lesions.

KEYWORDS
Fine Needle Aspiration Cytology, Breast Cancer, Infiltrating Duct Carcinoma

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Jebmh.com Original Research Article
BACKGROUND METHODS

Lesions of the breast are among the most common health In the present prospective study, fine needle aspiration was
problems in females. They primarily present with pain, done on the clinically palpable breast lumps, referred from
palpable mass, nipple discharge or structural abnormalities MIMS hospital to the Department of Cytopathology, Mandya
in the form of calcifications, opacities etc., on imaging Institute of Medical Sciences. The study was conducted for
studies.1 The incidence of breast cancer in recent decades a period of 1.5 years from January 2016 to June 2017. A
has increased worldwide, mainly due to improvements in total of 200 cases were included in this study.
screening and diagnosis, as well as to changes in the lifestyle All patients presenting to the cytopathology laboratory,
and habits of women. 2 Breast cancer is the most common Department of Pathology, MIMS, Mandya during the study
non skin malignancy in women and it is second only to the period with breast lesions, irrespective of age and sex, are
lung cancer as a cause of cancer death.3 Incidence of breast included in the study. The FNAC procedure was explained to
cancer increases with age like that of other epithelial the patient in their vernacular language. A written consent
tumours. Patients with breast cancer will have very good was taken before performing the FNAC. Data regarding the
prognosis if detected at an early stage.4 age of the patient, site of involvement, size of lesion and
According to GLOBOCAN 2012 project, breast cancer is relevant clinical history were recorded. FNA was done using
the second most common cancer in the world with an a 22 to 23 gauge needle and 10ml disposable syringe
incidence of 1.67 million cases. Breast cancer is the most mounted on Franzen’s handle. On an average 4 smears were
common cancer in women in India, way ahead of cervical prepared on. Few smears were kept for wet fixation in a
cancer. In India 1,44,937 women were newly detected with Coplin jar containing methanol and few slides were air dried.
breast cancer and 70,218 died of breast cancer. Male breast Wet fixed smears were stained with Haematoxylin and Eosin
carcinoma accounts for less than 1% of all cases (male and stain and air dried smears were stained with Leishman’s
female) of diagnosed breast cancer & less than 1% of all stain. Histopathological examination of the available biopsies
cancers in men.5 Breast cancer incidence peaks between the from the study was done. The biopsy specimens were fixed
ages of 40 and 50 year, with a mean age of occurrence at in 10% formalin for 24 hours and then grossed. The gross
47 years. Breast cancer patients in India mostly presents and cut section findings were noted. Several bits were taken
with palpable lump and with the lymph node metastasis at from appropriate sites for processing and paraffin
the time of diagnosis.6 A method of definitive diagnosis of embedding. From each block, sections were cut at 4-5
the breast lesions is therefore needed in order to reassure microns thickness and stained with Haematoxylin & Eosin
the patient and to offer best possible treatment.7 Fine needle stain for histopathological examination under light
aspiration cytology (FNAC) is a technique which is routinely microscope.
done on palpable lesions such as superficial growth of the
skin, subcutis, soft tissues and various organs of body like Inclusion Criteria
thyroid, breast, salivary glands and lymph nodes. It is All patients presenting to the cytopathology laboratory,
relatively simple, reliable, economical and complication free Department of Pathology, MIMS, Mandya during the study
procedure. With radiological techniques like ultrasound and period with breast lesions, irrespective of age and sex, are
computed tomography, material can be obtained through included in the study.
transthoracic and transperitoneal approaches from deep
seated lesions.8 The main purpose of FNAC of breast lesions Exclusion Criteria
is in investigation of any palpable breast lump and to avoid Uncooperative patients, repeat FNAC patients, patients with
unnecessary surgery. The advantages are-it is safe, diagnosed breast malignancy on treatment and patients with
accurate, and rapid technique. It does not require elaborate recurrent breast malignancy were excluded from the study.
tissue processing and is therefore less expensive method of
diagnosis. It does not require anaesthesia or hospitalization.
FNA can be done on palpable lesions either solid or cystic,
RE S UL T S
or deep seated non palpable lesions with the help of
ultrasound and mammography.9 It allows a number of
ancillary studies such as hormone receptor analysis, flow The present study includes fine needle aspirates (FNAs) from
cytometry and molecular diagnostic studies.10 FNAC has the palpable breast lesions of 200 cases spread over a period
superseded the use of frozen section examination in the 1.5 years from January 2016 to June 2017 at the
diagnosis and management of patients with breast cancer, Department of Pathology, Mandya Institute of Medical
and plays a major role as an important preoperative Sciences, Mandya. All the lesions were categorized into 5
assessment along with clinical correlation and categories C1 through to C5 as per National Cancer Institute
mammography which are referred to as the ‘Triple Test’.11 (NCI) reporting criteria- C1 (inadequate), C2- (benign), C3
We wanted to conduct a cytomorphological study of (atypia probably benign), C4 (suspicious of malignancy), C5
malignant breast lesions using fine needle aspiration (malignant). Out of 200 cases of breast FNACs evaluated,
cytology and Correlate the cytological diagnosis with histopathological correlation were available for 88 cases and
histopathology wherever surgical intervention is done. statistical tests were used to interpret the results. Among

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Jebmh.com Original Research Article
200 cases two cases were inadequate for evaluation, 160 which was followed by modified radical mastectomy. The cut
cases were benign, three cases were diagnosed as atypia section of mastectomy specimen revealed a soft grey white
probably benign, one case was diagnosed as suspicious of tumour with mucoid areas measuring 3 x 2.5 cms.
malignancy and 34 cases were diagnosed as malignant. Out Histopathology showed tumour cell clusters floating in lakes
of 34 malignant cases, majority of cases were in the age of mucus separated by delicate fibrous septae, thereby
group of 41 to 50 years followed by 31 to 40 years. Only one confirming the diagnosis.
case was found to be in age group of 81 to 90 years. (Table
1). Cytological Diagnosis

C5- Infiltrating Ductal

Age Frequency Percentage

C5- Metaplastic
C5- Medullary

C5- Mucinous

C5- Papillary
21-30 3 8.8

Carcinoma

Carcinoma

Carcinoma

Carcinoma

Carcinoma

Total
31-40 6 17.6
41-50 14 41.2
Valid 51-60 5 14.7
61-70 5 14.7
81-90 1 2.9
Total 34 100.0
Table 1. Age Distribution of C5-Malignant Breast Lesions Count 20 0 0 0 0 20
Infiltrating
% within
Ductal
cytological 95.2% 0.0% 0.0% 0.0% 0.0% 74.1%
Frequency Percentage Carcinoma
diagnosis
C5 - Infiltrating ductal carcinoma 28 82.4 Count 1 0 0 0 0 1
Infiltrating
C5 - Medullary carcinoma 1 2.9 % within
Lobular
C5 - Metaplastic carcinoma 1 2.9 cytological 4.8% 0.0% 0.0% 0.0% 0.0% 3.7%

Histopathological Diagnosis
Carcinoma
C5 - Mucinous carcinoma 3 8.8 diagnosis
C5 - Papillary carcinoma 1 2.9 Count 0 0 0 0 1 1
Invasive
% within
Total 34 100.0 papillary
cytological 0.0% 0.0% 0.0% 0.0% 100.0% 3.7%
Table 2. Cytological Diagnosis of C5 Lesions Carcinoma
diagnosis
Count 0 1 0 0 0 1
Medullary % within
Majority of lumps were located on left side of breast Carcinoma cytological 0.0% 100.0% 0.0% 0.0% 0.0% 3.7%
(19=55.9%) while 15 lumps were located on right side. diagnosis
Count 0 0 1 0 0 1
Among 34 cases, 16(47.1%) cases were located in upper Metaplastic % within
inner quadrant followed by 12 cases in upper outer Carcinoma cytological 0.0% 0.0% 100.0% 0.0% 0.0% 3.7%
diagnosis
quadrant, 3 cases in lower inner quadrant, 2 cases were Count 0 0 0 3 0 3
Mucinous % within
diffuse involving all quadrants of breast and one case was Carcinoma cytological 0.0% 0.0% 0.0% 100.0% 0.0% 11.1%
located in lower outer quadrant. Of the 34 malignant cases, diagnosis
Count 21 1 1 3 1 27
28 were reported as Infiltrating Ductal Carcinoma, Not % within
Total
Otherwise Specified (NOS) type, three cases were reported cytological 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%
diagnosis
as mucinous carcinoma breast on cytology, one case was Table 3. Cytological Diagnosis of C5 Breast Lesions with
reported as medullary carcinoma breast, one case was Histopathological Correlation
reported as papillary carcinoma breast and one case was
reported as metaplastic carcinoma breast on cytology. Malignant
Number of Cases
Cases in Sensitivity Specificity
(Table 2). Of the 34 malignant cases, 28 were reported as Biopsied
Cytology
infiltrating ductal carcinoma, Not Otherwise Specified (NOS) 34 27 100% 100%
type. Smears on cytology were moderately to highly cellular Table 4. Statistical Analysis of Malignant Lesions
and showed loosely Cohesive sheets and clusters of
pleomorphic ductal epithelial cells. Cells showed an enlarged One case was reported as Medullary Carcinoma breast
hyperchromatic nucleus, increased nuclear cytoplasmic on cytology. Cytology smears showed pleomorphic ductal
ratio, moderate to marked nuclear pleomorphism, coarse to epithelial cells in syncytial pattern, clusters and singles. The
granular to clumped chromatin with prominent nucleoli and cells had hyperchromatic nuclei with prominent nucleoli
irregular nuclear margins. Mitotic activity was also present. against lymphoplasmacytic background. Based on this,
Of these 28 cases, 20 underwent a surgical procedure with surgery was undertaken and the diagnosis was confirmed at
the excision of the neoplasm. The cytological diagnosis of histopathology. One case was reported as papillary
carcinoma was confirmed in all these cases. One case was carcinoma breast on cytology. Smears on cytology were
reported as infiltrating ductal carcinoma on cytology was cellular and features were suggestive of papillary carcinoma
diagnosed as infiltrating lobular carcinoma on which was followed by surgery. Histopathology showed a
histopathology. Three cases were reported as Mucinous cellular tumour comprised of pleomorphic ductal epithelial
Carcinoma breast on cytology. On cytology, smears were cells arranged predominantly in papillary pattern with fine
moderately cellular and showed ductal epithelial cells with fibrovascular core invading into stroma. The papillae were
abundant cytoplasm arranged in clusters and singles. The lined by tumour cells with high nucleocytoplasmic ratio,
cells showed moderate nuclear pleomorphism. The cells hyperchromatic nuclei along with areas of haemorrhage and
clusters were suspended in abundant mucin background. A necrosis. One case was reported as metaplastic carcinoma
cytological diagnosis of mucinous carcinoma was given breast on cytology. Cytology smears showed mixed
population of malignant ductal epithelial cells of variable

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Jebmh.com Original Research Article
morphology and spindle cells which was followed by surgery. C O N C L US I O N S
Histopathology showed pleomorphic malignant epithelial
cells, spindle cells. Among these 34 cases, 27 cases were
Fine needle aspiration cytology is an efficient, rapid,
available for histopathological correlation which proved to be
inexpensive, safe and reliable diagnostic method. It causes
malignant on histopathology also. (Table 3). Therefore,
minimum morbidity with very less complications and has
FNAC proved to be 100% sensitive and specific in the
excellent patient acceptance. It helps in deciding the mode
diagnosis of malignant lesions in our study. (Table 4).
of surgery. In spite of its few limitations, FNAC has high
levels of diagnostic accuracy when it is performed by an
experienced pathologist. The high specificity and high
DISCUSSION negative predictive value for malignancy illustrated the high
accuracy of FNAC in the diagnosis of malignancy in the
Fine-needle aspiration cytology is widely used in the breast. Therefore, we conclude that the diagnosis of breast
diagnosis of breast cancer because it is an excellent, safe, lesions based on FNAC should be practiced as a routine
and cost-effective diagnostic procedure. FNAC of the breast procedure as there is high degree of correlation with
can reduce the number of open breast biopsies.12 Our study histopathological findings. Thus, FNAC is an effective and
included 34 cases with palpable breast lumps in which valid tool as the first line diagnostic modality in the
cytomorphological features of malignant breast lesions were preoperative diagnosis and management of both benign and
studied in detail and the cytological results were malignant breast lesions.
subsequently compared with that of histopathology in
available cases. In C5 category, 34 (17%) cases were
reported as malignant lesions presenting most commonly in RE F E R E N C E S
age group of 41-50 years, among which 28 (82.4%) cases
were ductal carcinoma (most common). Rahman et al 13 and [1] Prem S, Manish C, Samal N, et al. Cytomorphological
Khemka A14 reported 14.17% and 22% of malignant cases patterns of breast lesions diagnosed on fine-needle
respectively which were close to our study. However Singh aspiration cytology in a tertiary care hospital. Int J Med
A15 reported a lower incidence of 8.82% while Bukhari et al12 Sci Public Health 2015;4(5):674-679.
reported a higher rate of 31% cases of malignant lesions. [2] Santos GT, Prolla JC, Camillo ND, et al. Clinical and
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