A Correlative Study of Fine Needle Aspiration Cytology with Histopathology of Female Breast Lesions

Abstract

BACKGROUND Breast lesions remain a major public health problem worldwide. Fine needle aspiration cytology (FNAC) has become one of the first-line investigations for the diagnosis of breast lumps. Although one of the major goals of FNAC is to differentiate benign from malignant lesions, in certain cases, this may not possible due to a lack of uniformity with regards to the reporting terminology used in breast cytology by pathologists worldwide, resulting in poor communication of results 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 Cancer Institute (NCI) recommended terminology by correlating with histopathological examination (HPE) results. METHODS In this retrospective study conducted over a period of two years, a total of 382 female patients with breast lesions underwent FNAC and was categorized according to the NCI guidelines. Of these, 156 cases had histopathological follow-up and their FNAC diagnoses were compared. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) along with 95% confidence interval (95% CI) and accuracy of FNAC were calculated. RESULTS Among the 156 cases, none were unsatisfactory (C1); 105 (67.1%) were benign (C2); 7 (4.4%) were atypical but probably benign (C3); 2 (1.1%) were suspicious favouring malignancy (C4); 43 (27.4%) were malignant (C5). Cyto-histopathological correlation was carried out. Of categories C2 and C3 (total of 112 cases), 109 were confirmed as benign (true negative) and the remaining 3 cases turned out to be malignant (false negative). Of categories C4 and C5 (total of 45 cases), all cases were confirmed as malignant (true positive) and none were benign ( false positive). The present study showed a sensitivity, specificity, PPV, NPV and accuracy of 93.62% (95% CI, 82.46%-98.66%), 100% (95% CI, 96.67%-100%), 100% (95% CI, 92.5%99.6%), 97.32% (95% CI, 92.4%-99.09%) and 98.08% respectively. 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.