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ORIGINAL ARTICLE
Year : 2017  |  Volume : 10  |  Issue : 4  |  Page : 339-342  

Study of fine-needle aspiration cytology of breast lumps in rural area of Bastar district, Chhattisgarh


1 Department of Pathology, Late Shri Baliram Kashyap Memorial Government Medical College, Jagdalpur, Chhattisgarh, India
2 Department of Anatomy, Late Shri Baliram Kashyap Memorial Government Medical College, Jagdalpur, Chhattisgarh, India

Date of Submission02-May-2017
Date of Acceptance10-May-2017
Date of Web Publication4-Sep-2017

Correspondence Address:
Sachin A Badge
Department of Pathology, Late Shri Baliram Kashyap Memorial Government Medical College, Jagdalpur, Chhattisgarh - 494 001
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/MJDRDYPU.MJDRDYPU_250_16

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  Abstract 

Aims and Objectives: In India, breast cancer is the second most common cancer in women. The fine-needle aspiration cytology (FNAC) of breast lump is highly sensitive, easy to perform, and cost effective that can be carried out at outpatient department. The aim of this study is to identify the most common benign and malignant tumors of the breast lump on FNAC in our institute. Materials and Methods: The present study was carried out in the Pathology Department of our institute over 2 years from January 2014 to December 2015. Procedure is done using 24-gauge needle fitted on 10 ml disposable syringe in syringe holder. The wet smear fixed with ether-alcohol mixture stained with hematoxylin and eosin and papanicolaou stain. The air-dried smear stained with May-Grunwald Giemsa stain. Results: A total of 731 cases were obtained in the cytopathology section over 2 years from January 2014 to December 2015, out of which 220 (30.10%) cases were breast lump FNACs. Benign tumors contributed to 162 cases (73.64%) and malignant tumors to 58 cases (26.36%). Among benign tumor, fibroadenoma was the most common tumor which constituted 121 cases (55%). Infiltrating duct carcinoma was the most common malignant breast tumor in the present study comprising 53 cases (24.09%). Conclusion: The most common benign tumor in the present study was fibroadenoma and the most common malignant tumor was invasive ductal carcinoma.

Keywords: Breast lumps, fibroadenoma, fine-needle aspiration cytology, infiltrating duct carcinoma


How to cite this article:
Badge SA, Ovhal AG, Azad K, Meshram AT. Study of fine-needle aspiration cytology of breast lumps in rural area of Bastar district, Chhattisgarh. Med J DY Patil Univ 2017;10:339-42

How to cite this URL:
Badge SA, Ovhal AG, Azad K, Meshram AT. Study of fine-needle aspiration cytology of breast lumps in rural area of Bastar district, Chhattisgarh. Med J DY Patil Univ [serial online] 2017 [cited 2017 Sep 20];10:339-42. Available from: http://www.mjdrdypu.org/text.asp?2017/10/4/339/213934


  Introduction Top


Breast lump is the most common presentation in most of the breast diseases. In India, breast cancer is the second most common cancer in women.[1] Most of the cases in breast lesions are benign.[2] The fine-needle aspiration cytology (FNAC) was first introduced by the Martin and Ellis in 1930.[3] The FNAC of breast lump is highly sensitive, easy to perform, and cost effective that can be carried out at outpatient department.[4],[5] FNAC has various benefits over the open tissue biopsy.[6] It is rapid and reliable procedure. It helps in planning of treatment in the breast lump, and we can also perform molecular ancillary technique, i.e., progesterone receptor and estrogen receptor, proliferation antigen (Ki67), and DNA pattern analysis. Thus, the FNAC has reduced the number of open breast biopsies. Accuracy in the diagnosis can be increased by multiple sampling of appropriate sites by ultrasonography guidance and/or mammographic localization.[7] That is why FNAC is regarded as preliminary diagnostic procedure, as a screening procedure with or without ultrasonography or stereotactic guidance, or as a follow-up procedure for postmastectomy or lumpectomy. The aim of this study was to find the common causes of breast lump in our institute.


  Materials and Methods Top


The present study was carried out in the Pathology Department of our institute over 2 years from January 2014 to December 2015 after taking permission from ethical committee of institution. The patients with palpable breast lump referred from general surgery department in the institution for FNAC were involved in the study. The case history of the patient was recorded, includes detail history of pain, nipple discharge, ulceration of nipple, and duration of lesion. The examination of breast lump was done with recording of size and site of lump, consistency, fixation to skin and underline tissue, and retraction of nipple along with regional lymph node involvement. Consent was taken after due explanation of the procedure and its benefit to the patients. Procedure is done using 24-gauge needle fitted on 10 ml disposable syringe in syringe holder. The wet smear fixed with ether-alcohol mixture stained with hematoxylin and eosin and papanicolaou stain. The air-dried smear stained with May-Grunwald Giemsa stain.


  Results Top


A total of 731 cases were obtained in the cytopathology section over 2 years from January 2014 to December 2015, out of which 220 (30.10%) cases were breast lump FNACs. All the 220 patients underwent a diagnostic FNAC in our Pathology Department. In the present study, males contributed 6 cases (2.73%) and females contributed 214 cases (97.27%). Male-to-female ratio in the study was 1:35.67. Age range of patients varied from 12 years to 78 years [Table 1]. The youngest patient was 12 years old and diagnosed with fibroadenoma. The most aged patient was of 78 years old and diagnosed with infiltrating duct carcinoma. Among female, maximum cases were noted in the fourth decade, i.e. 99 cases (45%). In all 6 cases of male patients, diagnosis of gynecomastia was given. [Table 2] shows various types of diagnoses given on FNAC. [Table 3] shows age-wise distribution of various breast lump lesions. Maximum cases of fibroadenoma were found in the fourth decade (63 cases), whereas maximum cases of infiltrating duct carcinoma were found in the fifth decade (27 cases). Out of all breast lump lesions, benign tumors were more common than malignant tumors. Benign tumors contributed to 162 cases (73.64%) and malignant tumors to 58 cases (26.36%). Among benign tumor, fibroadenoma [Figure 1] was the most common tumor which constituted 121 cases (55%). Infiltrating duct carcinoma [Figure 2] and [Figure 3] was the most common malignant breast tumor in the present study comprising 53 cases (24.09%).
Figure 1: Fibroadenoma (H and E, ×10)

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Figure 2: Infiltrating duct carcinoma (H and E, ×10)

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Figure 3: Infiltrating duct carcinoma (H and E, ×40)

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Table 1: Age-wise distribution of cases

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Table 2: Fine-needle aspiration cytology diagnosis of 220 cases of breast lesions

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Table 3: Age-wise distribution of various breast lump lesions

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  Discussion Top


There has been an increasing use of cytology techniques as diagnostic tools in the preoperative assessment of patients with breast lesions. This is due to high level of awareness among the clinicians of the role of cytology techniques, as a useful diagnostic tool and necessary adjunct to clinical examination. Furthermore, these techniques are well tolerated by patients and meet their expectations in a timely response to their concerns. The benign lesions of the breast are the most common lesions in the young adults and middle-age groups, and this reflects the increase in awareness of patients and their desire for early detection and medical care. This study has highlighted several potential benefits of fine-needle aspiration (FNA). The most important is that FNA is a simple, safe, and cost-effective method as the first line of investigation of palpable breast lumps, particularly in low-resource settings. Furthermore, the diagnosis of benign lesions is two folds that of malignant ones, this is an indicator of increased awareness in the community as well as clinicians recognizing the practicability of FNAC. The application of FNAC for the diagnosis of palpable breast masses was first introduced by Martin and Ellis in 1930, and since then, it has been established as an important tool in the evaluation of breast lesions.[3] The percentage of benign tumors in the present study was 73.64% (162 cases). This was similar to findings of study done by Bukhari et al., Rocha et al., Feichter et al., and Singh et al.[8],[9],[10],[11] The percentage was more as compared to findings of study done by Bell et al. and Mohammad et al.[12],[13] In the present study, percentage of malignant cases was 26.36% (58 cases); this was more or less similar to the findings of Bukhari et al. and Mohammad et al.[8],[13] This percentage was more than findings of study done by Bell et al., Rocha et al., Feichter et al., Singh et al., Shrestha et al., and Rupom and Choudhary [9],[10],[11],[12],[14],[15] Fibroadenoma was the most common benign lesion in this study which was concurrent with the findings of Bell et al., and invasive duct carcinoma was the most common malignant lesion which was similar to findings of study done by Mohammad et al.[12],[13]


  Conclusion Top


The FNAC of breast is cheap, safe, and highly accurate method for diagnosis of breast lump preoperatively to avoid undue surgery and inconvenience during biopsy. FNAC of breast lump should be used as preliminary investigation in outdoor patient department. The same aspirate can also be used for ancillary molecular testing. The most common benign tumor in the present study was fibroadenoma and the most common malignant tumor was invasive ductal carcinoma.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Sandhu DS, Sandhu S, Karwasra RK, Marwah S. Profile of breast cancer patients at a tertiary care hospital in North India. Indian J Cancer 2010;47:16-22.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Cochrane RA, Singhal H, Monypenny IJ, Webster DJ, Lyons K, Mansel RE. Evaluation of general practitioner referrals to a specialist breast clinic according to the UK national guidelines. Eur J Surg Oncol 1997;23:198-201.  Back to cited text no. 2
    
3.
Martin HE, Ellis EB. Biopsy by needle puncture and aspiration. Ann Surg 1930;92:169-81.  Back to cited text no. 3
    
4.
Rimm DL, Stastny JF, Rimm EB, Ayer S, Frable WJ. Comparison of the costs of fine-needle aspiration and open surgical biopsy as methods for obtaining a pathologic diagnosis. Cancer 1997;81:51-6.  Back to cited text no. 4
    
5.
Silverman JF, Lannin DR, O'Brien K, Norris HT. The triage role of fine needle aspiration biopsy of palpable breast masses. Diagnostic accuracy and cost-effectiveness. Acta Cytol 1987;31:731-6.  Back to cited text no. 5
    
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Bojia F, Demisse M, Dejane A, Bizuneh T. Comparison of fine-needle aspiration cytology and excisional biopsy of breast lesions. East Afr Med J 2001;78:226-8.  Back to cited text no. 6
    
7.
Rathod GB, Goyal R, Bhimani RK, Goswami SS. Metaplastic carcinoma of breast in 65 years old female – A case report. Med Sci 2014;10:77-81.  Back to cited text no. 7
    
8.
Bukhari MH, Arshad M, Jamal S, Niazi S, Bashir S, Bakhshi IM, et al. Use of fine-needle aspiration in the evaluation of breast lumps. Patholog Res Int 2011;2011:689521.  Back to cited text no. 8
    
9.
Rocha PD, Nadkarni NS, Menezes S. Fine needle aspiration biopsy of breast lesions and histopathologic correlation. An analysis of 837 cases in four years. Acta Cytol 1997;41:705-12.  Back to cited text no. 9
    
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Feichter GE, Haberthur F, Gobat S, Dalquen P. Statistical analysis and cytohistologic correlations. Acta Cytol 1973;17:188-90.  Back to cited text no. 10
    
11.
Singh K, Sharma S, Dubey VK, Sharma PR. Role of FNAC in diagnosis of breast lumps. JK Sci 2001;3:126-8.  Back to cited text no. 11
    
12.
Bell DA, Hajdu SI, Urban JA, Gaston JP. Role of aspiration cytology in the diagnosis and management of mammary lesions in office practice. Cancer 1983;51:1182-9.  Back to cited text no. 12
    
13.
Mohammad Q, Akbar SA, Ali J, Mustafa S. Lump in breast; role of FNAC in diagnosis. Prof Med J 2009;16:235-8.  Back to cited text no. 13
    
14.
Shrestha A, Chalise S, Karki S, Shakya G. Fine needle aspiration cytology in a palpable breast lesion. J Pathol Nepal 2011;1:131-5.  Back to cited text no. 14
    
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Rupom T, Choudhary T. Study of fine needle aspiration cytology of breast lump: Correlation of cytologically malignant cases with their histological findings. Bangabandhu Sheikh Mujib Med Univ J 2011;4:60-4.  Back to cited text no. 15
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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Abstract
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