The diagnosis of malignant breast lumps using fine needle aspiration cytology and ultrasonography versus histopathology
Background and objective: The most common cancer of women worldwide is breast cancer and usually presents as a breast lump. Fine needle aspiration cytology and ultrasonography are two investigational techniques used to differentiate malignant breast lump from benign one. This study aimed to find out and compare the specificity, sensitivity, and predictive values of ultrasonography versus fine needle aspiration cytology for the diagnosis of malignant breast lump.
Methods: Patients who presented with clinically palpable breast lump at the department of Surgery, Rizgary Teaching Hospital, Erbil, from October 2014 to March 2016, were included. The age of the study participants ranged from 15 to 56 years. The highest rate (28.9%) was among the age group 35-45 years. Breast abscess, cystic breast lumps, and recurrent lumps have been excluded. The ultrasonographic evaluation was done by using 7.5 MHz probe for all patients at the department of radiology and fine needle aspiration cytology at the department of histopathology. All the patients underwent excision of the lumps, and histopathological examination was done for tissues. Specificity, sensitivity, and predictive values of ultrasonography and fine needle aspiration cytology were estimated, taking the histopathological result as the gold standard. A comparison of values was made.
Results: Ninety patients with 93 breast lumps were included in this study. Fine needle aspiration cytology reported 28 lumps as malignant lumps and 63 as benign, and two cases were indeterminate. Ultrasonography reported 27 cases as malignant, 54 as benign, and nine as indeterminate, while three breast lumps were failed to be detected. Sensitivity, specificity, positive and negative predictive values of ultrasonography and fine needle aspiration cytology in diagnosing malignant breast lump were 94.74%, 100%, 100%, 97.22%, and 90.48%, 100%, 100%, 95.24%,respectively.
Conclusion: Ultrasonography and fine needle aspiration cytology are 100% specific in diagnosing malignant breast lesions. Although ultrasonography appears more sensitive than fine needle aspiration cytology, it has a higher percentage of the indeterminate report.
Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 2010; 127(12):2893–917.
Rahman MZ, Islam S. Fine needle aspiration cytology of palpable breast lump: A study of 1778 cases. Surgery 2013; S12:001.
Obaseki DE, Olu-Edo AN, Ogunbiyi JO. Diagnostic accuracy of fine needle aspiration cytology of palpable breast masses in Benin City, Nigeria. West Afr J Med 2010; 29(4):259–62.
Tiwari M. Role of fine needle aspiration cytology in diagnosis of breast lumps. Kathmandu Univ Med J 2007; 5(2):215–7.
Pruthi S. Detection and evaluation of a palpable breast mass. Mayo Clin Proc 2001; 76:641–8.
Lieu D. Value of cytopathologist-performed ultrasound-guided fine-needle aspiration as a screening test for ultrasound-guided core-needle biopsy in non palpable breast masses. Diagn Cytopathol 2009; 37(4):262–9.
Ukah CO, Oluwasola OO. The clinical effectiveness of fine needle aspiration biopsy in patients with palpable breast lesions seen at the University College Hospital, Ibadan, Nigeria: A 10-year retrospective study. J Cytol 2011; 28(3):111–3.
Jindal U, Singh K, Kochhar A. Fine needle aspiration cytology of breast lumps with histopathological correlation: A four year and eight month study from rural India. Internet J Pathol 2012; 13:3.
Gukas ID, Nwana EJC, Ihezue CH, Momoh JT, Obekpa PO. Tru-cut biopsy of palpable breast lesions: A practical option for pre operative diagnosis in developing countries. Cent Afr J Med 2000; 46(5):127–30.
Ghazala M, Waqar F, Ghulam QB. Sonomammography for evaluation of solid breast masses in young patients. J Ayub Med Coll Abbottabad 2006; 18(2):34–7.
Homesh NA, Issao MA, El-Sofiani HA. The diagnostic accuracy of fine needle aspiration cytology versus core needle biopsy for palpable breast lumps. Saudi Med J. 2005; 26(1):42–46.
Reinikainen HT, Rissanen TJ, Piippo UK, Päivänsalo MJ. Contribution of ultrasonography and fine-needle aspiration cytology to the differential diagnosis of palpable solid breast lesions. Acta Radiol 1999; 40(4):383–89.
Rahman MZ, Sikder AM, Nabi SR. Diagnosis of breast lump by fine needle aspiration cytology and mammography. Mymensingh Med J 2011; 20(4):658–64.
Tham T-M, Iyengar KR, Taib NA, Yip C-H. Fine needle aspiration biopsy, core needle biopsy or excision biopsy to diagnose breast cancer - Which is the ideal method? Asian Pacific J Cancer Prev 2009; 10:155–8.
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.
Bakhos R, Selvaggi SM, DeJong S, Gordon DL, Pitale SU, Herrmann M, et al. Fine-needle aspiration of the thyroid: rate and causes of cytohistopathologic discordance. Diagn Cytopathol 2000; 23(4):233–7.
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