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 Table of Contents  
ORIGINAL ARTICLE
Year : 2015  |  Volume : 6  |  Issue : 1  |  Page : 16-22

A clinicopathologic study of various breast lesions with cytohistological correlation


1 Department of Pathology, Lala Lajpat Rai Memorial Medical College, Meerut; Department of Pathology, Sarojini Naidu Medical College, Agra, India
2 Department of Surgery, Mayo Institute of Medical Sciences, Lucknow; Department of Surgery, Sarojini Naidu Medical College, Agra, India
3 Department of Psychiatry, Subharti Medical College, Meerut, Uttar Pradesh, India
4 Department of Urosurgery, Postgraduate Institute of Medical Sciences, Chandigarh, India
5 Department of Pathology, Lala Lajpat Rai Memorial Medical College, Meerut, India

Date of Web Publication8-Dec-2014

Correspondence Address:
Monika Rathi
Lala Lajpat Rai Memorial Medical College, Meerut, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0975-9727.146416

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  Abstract 

Context: Most of the females suffer from breast diseases during their life at some time or the other. Confirmation of breast diseases by clinical examination and pathological confirmation by fine needle aspiration cytology (FNAC) and histopathologic examination has been found to be an important part of diagnostic workup in breast diseases. Aims: To establish a clinicopathologic correlation in patients suffering from breast diseases. Settings and Design: We conducted a prospective study from December 2008 to August 2010. One hundred and twenty-one cases were enrolled using simple random sampling methods. Materials and Methods: Data including age, complaints, and clinical examination was collected from patients presenting for FNAC with breast complaints. Results: A total of 128 cases were studied which included 101 benign cases, 21 malignant cases, and 6 inadequate cases. The final 122 cases included 3 (2.5%) cases of acute mastitis, 2 cases (1.6%) of tubercular mastitis, 44 cases (36.1%) of fibroadenoma, 42 cases (34.4%) of benign breast disease with non-specific descriptive diagnosis, 2 cases (1.6%) of fibrocystic disease, 3 cases (2.5%) of galactocele, 1 (0.9%) case of lactational adenoma, 2 cases (1.6%) of cellular fibroadenoma, and 2 cases (1.6%) of phyllodes tumor. Apart from this, there were 21 cases (17.21%) of ductal carcinoma. Majority of benign cases were between 30 and 39 years of age (43.6%). Majority of malignant cases fell between 50 and 59 years of age (47.6%). Majority (61.5%) of lumps (>3 cm) were malignant, whereas 94.8% of lumps (<3 cm) were benign. Left breast was commonly involved (49.18%) than the right breast (44.26%). Superolateral quadrant (63.1%) was the most commonly involved quadrant. Histology was available for 35 benign cases (34.65%) and out of total malignant cases (21), histology was available for 14 cases (66.66%). No discrepancy was noted.

Keywords: Breast, clinicopathologic correlation, ductal carcinoma


How to cite this article:
Rathi M, Khalid M, Budania SK, Mittal A, Verma N. A clinicopathologic study of various breast lesions with cytohistological correlation. Muller J Med Sci Res 2015;6:16-22

How to cite this URL:
Rathi M, Khalid M, Budania SK, Mittal A, Verma N. A clinicopathologic study of various breast lesions with cytohistological correlation. Muller J Med Sci Res [serial online] 2015 [cited 2019 Oct 16];6:16-22. Available from: http://www.mjmsr.net/text.asp?2015/6/1/16/146416


  Introduction Top


Breast lesions are one of the most commonly encountered lesions in women. All physicians accept the necessity of obtaining prompt pathological confirmation of the nature of any mass in the breast suspected as benign or malignant. Since the most important prognostic factor at the time of presentation is the extent of the disease, it is imperative that a reliable preoperative diagnosis is established as early as possible with a view to institute proper treatment and reduce the mortality rates. In recent years, mammary cytology has been considered as an effective means of early diagnosis of breast masses. [1]

Fine needle aspiration cytology (FNAC) has also been found as a very important tool in the assessment of breast masses. Various modalities have been used in breast carcinoma, which include clinical examination, mammography, xeroradiography, thermography, fine needle cytology, and open biopsy. The combination of fine needle cytology, clinical examination, and mammography has been suggested as a triple test for the preoperative diagnosis of breast masses. [2]

The advantage of these cytological procedures lies in the fact that they are simple to perform, cost-effective, rapidly accepted by the patient, and cosmetically least disfiguring. This more rapid diagnostic approach helps to allay the anxiety caused by delays in scheduling, performing, and interpreting an open biopsy.

A benign diagnosis allows surgery to be avoided in the majority of cases, while a positive diagnosis of carcinoma allows preoperative discussion with the patient and proper treatment planning with minimal morbidity. [3]

So, this study was conducted to establish a clinicopathologic correlation in the patients suffering from breast diseases.


  Materials and Methods Top


This prospective study was conducted at a tertiary teaching center from December 1, 2008 to August 31, 2010. This study was approved by the ethical committee of the college. A total of 128 patients who were advised FNAC by the surgery department during this period were enrolled by simple random sampling method without any bias. These patients were examined clinically with a detailed clinical history and radiological findings, and then cytohistological correlation was done.

These cases were classified as inflammatory lesions, benign lesions, and malignant lesions.


  Results Top


A total of 128 cases were subjected to FNAC. Out of these, six cases were inadequate as shown in [Figure 1]. These six patients did not turn up for re-aspiration or histology. Also, 21 cases (17.21%) were malignant and 101 cases (82.79%) were benign as shown in [Figure 2].
Figure 1: Distribution of cases according to adequacy

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Figure 2: Distribution of benign and malignant cases

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Out of 122 cases, the maximum number of cases were benign (101, 82.79%) and fibroadenoma cases (44, 36.1%) as shown in [Table 1].
Table 1: Distribution of cases according to diagnosis

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One hundred and twenty-two cases were included in the present study. The cases were between 16 and 64 years of age. The youngest patient was 16 years old and the oldest patient was 64 years old. The maximum number of cases was in 30-39 years age group (37.70%) as shown in [Figure 3].
Figure 3: Distribution of cases according to age

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The age of all benign cases ranged from 16 to 64 years, with a majority of cases between 30 and 39 years (43.6%) as shown in [Figure 4].
Figure 4: Age distribution of benign cases

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The age of malignant cases fell between 33 and 64 years; the age range of a maximum number of cases fell between 50 and 59 years (47.6%) as shown in [Figure 5].
Figure 5: Age distribution of malignant cases

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Majority of the cases were seen in superolateral quadrant (63.1%) [Figure 6].
Figure 6: Quadrant-wise case distribution

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Out of 122 cases, 60 cases (49.18%) were in left breast, 54 cases (44.26%) were in right breast, and 8 cases (6.55%) presented bilaterally [Figure 7].
Figure 7: Distribution according to laterality

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The size of lumps ranged from 2 to 7 cm. The breast lumps were less than 3 cm in 96 cases. Out of 96 cases, 94.8% cases were benign and 5.2% cases were malignant. Among the cases which were more than 3 cm in size, 10 cases (38.5%) were benign and 16 cases (61.5%) were malignant as shown in [Figure 8].
Figure 8: Case distribution according to size of lumps

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Overall, breast lump with pain was the most common presenting complaint, accounting up to 39.34%, as shown in [Figure 9].
Figure 9: Different types of presentation

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In the present study, out of 101 benign cases, histology was available for 35 cases (34.65%); out of total malignant cases (21), histology was available for 14 cases (66.66%) [Figure 10], [Figure 11], [Figure 12], [Figure 13], [Figure 14], [Figure 15], [Figure 16], [Figure 17]. Out of these histologically confirmed ductal carcinoma cases, majority of the cases (9) were in Stage 2 (on the basis of TNM staging), three cases were categorized in Stage 3, and only two cases were categorized in Stage 4. No discrepancy was noted as shown in [Table 2].
Figure 10: Cytology of ductal hyperplasia (May Grunwald Giemsa, 400×)

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Figure 11: Histology of ductal hyperplasia with fibrocystic disease
(Haematoxylin and Eosin, 100×)


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Figure 12: Cytology of fi broadenoma (May Grunwald Giemsa, 400×)

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Figure 13: Histology of fi broadenoma (Haematoxylin Eosin, 400×)

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Figure 14: Cytology of phyllodes tumor (May Grunwald Giemsa, 100×)

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Figure 15: Histology of phyllodes tumor (Haematoxylin Eosin, 400×)

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Figure 16: Cytology of ductal carcinoma (May Grunwald Giemsa, 400×)

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Figure 17: Cytology of ductal carcinoma (Haematoxylin Eosin, 400×)

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Table 2: Cytohistological correlation

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  Discussion Top


In this study, 128 cases were studied, of which 6 cases (4.69%) were inadequate [Figure 1]. Similar inadequacy rate was achieved by Zajdela et al., [4] and Jayaram et al., [5] in their studies on breast masses.

In this study of 128 cases, 21 cases (17.21%) were malignant and 82.79% cases were benign [Figure 2]. Yeoh et al., [6] studied 1533 breast masses on FNAC and found that 70.4% cases were benign and 4.4% cases were malignant. Similarly, Ganiat et al., [7] studied 757 cases on FNAC and found that maximum number of cases were benign (50.2%), which was followed by malignant cases (31.4%), suspicious malignant cases (9.5%), and inflammatory cases (7.4%).

The percentage of benign cases in our study was closer to that of Yeoh et al.

In the present study, 101 cases (82.79%) were benign with maximum number of cases of fibroadenoma (44/128), followed by benign breast lesions with non-specific descriptive diagnosis (42/128), acute mastitis (3/128), galactocele (3/128), tubercular mastitis (2/128), cellular fibroadenoma (2/128), phyllodes tumor (2/128), fibrocystic disease (2/128), and lactational adenoma (1/128). Twenty-one cases were malignant in the present study. Aslam [8] also documented fibroadenoma as the most common benign lesion (71.3%) in their study.

Unlike our study, Jayaram et al., [5] in their study of 543 cases of FNAC found fibrocystic disease (39.8%) as the most common lesion. Pattari et al., [9] studied 71 histologically confirmed cases and documented infiltrating ductal carcinoma as the most common lesion (24/71).

The patients in our study were between 16 and 64 years of age with maximum incidence in the age group of 30-39 years (46 cases, 37.7%). The age of all benign cases ranged from 16 to 64 years with a majority of cases between 30 and 39 years of age (44 cases, 43.6%). The age of malignant cases ranged from 33 to 64 years with a majority of cases in the age group of 50-59 years (10 cases, 47.6%).

Hussain et al., [10] and Khemka et al., [11] studied 50 patients and they also found that the maximum number of patients were in the age group of 31-40 years. Khemka et al., [11] observed that benign lesions of breast were more commonly seen in younger age groups with maximum number of patients found in the age group 30-34 years. Ganiat et al., [7] reported maximum number of patients with malignant lesions in the fourth to seventh decade of life.

Among all four quadrants, superolateral quadrant was the most common quadrant for breast lesions in the present study (77 cases, 63.1%). Hussain et al., [10] and Khemkha et al., [11] also observed upper and outer quadrant as the commonest site.

Out of 122 cases, 60 cases (49.18%) were in left breast, 54 cases (44.26%) were in right breast, and 8 cases (6.55%) presented bilaterally.

Hussain et al., [10] reported left breast involvement in 27 patients (54%) and right breast involvement in 23 cases (46%) and concluded similarly that left breast was involved more commonly than right.

In the present study, all the palpable breast lumps were in range of 2-7 cm and 96 breast lumps measured less than 3 cm, of which 5 cases (5.2%) were malignant. In lumps measuring more than 3 cm, 16 patients (61.5%) were malignant out of 26 cases [Figure 8].

Ballo et al., [12] studied 112 cases of the lumps with a size range of 1-12 cm and reported that 73.8% of the lumps with a larger size (>2 cm) and 28.38% with a size <2 cm were malignant.

Overall, breast lump with pain was the most common presenting complaint accounting up to 39.34%.

Correlation of Clinical Examination and FNAC with Histopathologic Examination

Radiological investigation was available for 23 benign cases and 5 malignant cases. Clinico-radiological findings were concordant in 22 benign and 4 malignant cases.

One benign case which was clinico-radiologically diagnosed as fibrocystic disease was found to be tubercular mastitis on FNAC, and one case diagnosed as benign breast disease, both clinically and radiologically, was found to be malignant on cytology.

In the present study, out of 101 benign cases, histology was available for 35 cases (34.65%) and out of malignant cases (21), histology was available for 14 cases (66.66%). No discrepancy was noted. So, considering histological diagnosis as the gold standard, we found that the sensitivity and specificity of FNAC to detect benign and malignant cases was 100% in our series. There was 100% cytological and histological correlation. However, we found that the sensitivity and specificity of clinico-radiological investigation to detect a benign case was 100% and 95.45%, respectively. The sensitivity and specificity to detect a malignant case on clinico-radiological examination was found to be 95.23% and 100%, respectively. We used the following formula to detect sensitivity and specificity:

sensitivity = true positive/true positive + false negative

specificity = true negative/true negative + false positive

Limitations

Only those cases that were advised FNAC by the surgery department were included in the study. A large number of cases of benign breast diseases are not advised FNAC. The histopathologic confirmation was not available in 100% of the cases. The reason behind this was that majority of the lesions were benign and the patients refused to undergo histopathologic confirmation.


  Conclusion Top


We found 100% correlation between FNAC and histology. This reconfirms the fact that clinical examination of the patient and FNAC are important part of triple assessment of a patient.


  Acknowledgment Top


The authors acknowledge engineer Ayush for his technical help.

 
  References Top

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Cangiarella J, Simsir A. Breast. In: Orell SR, Sterrett GF, Whitaker D, editors. Fine Needle Aspiration Cytology. 4 th ed. New Delhi, India: Elsevier Publication; 2005. p. 165-217.  Back to cited text no. 1
    
2.
Martelli G, Pilotti S, Coopmans de Yoldi G, Viganotti G, Fariselli G, Lepera P, et al. Diagnostic efficacy of physical examination, mammography, fine needle aspiration cytology (triple-test) in solid breast lumps: An analysis of 1708 consecutive cases. Tumori 1990;76:476-9.  Back to cited text no. 2
    
3.
Saad RS, Silverman JF. Breast. In: Bibbo M, Wilbur DC, editors. Comprehensive Cytopathology. 2 nd ed. Philadelphia, PA: Elsevier Publication; 1997. p. 713-5.  Back to cited text no. 3
    
4.
Zajdela A, Zillhardt P, Voillemot N. Cytological diagnosis by fine needle sampling without aspiration. Cancer 1987;59:1201-5.  Back to cited text no. 4
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5.
Jayaram G, Alhady SF, Yip CH. Cytological analysis of breast lesions: A review of 780 cases. Malaysian J Pathol 1996;18:81-7.  Back to cited text no. 5
    
6.
Yeoh GP, Chan KW. Fine needle aspiration of breast masses: An analysis of 1533 cases in private practice. Hong Kong Med J 1998;4:283-8.  Back to cited text no. 6
    
7.
Ganiat O, Omoniyi-Esan G, Osasan S, Titiloye N, Olasode B. Cytopathological review of breast lesions in Ile-Ife Nigeria. The Internet J. of Third World Med.2008;8:10-25.  Back to cited text no. 7
    
8.
Aslam HM, Saleem S, Shaikh HA, Shahid N, Mughal A, Umah R. Clinico- pathological profile of patients with breast diseases. Diagn Pathol 2013;8:77.   Back to cited text no. 8
    
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Pattari SK, Dey P, Gupta SK, Joshi K. Myoepithelial cells: Any role in aspiration cytology smears of breast tumours? Cytojournal 2008;5:9.  Back to cited text no. 9
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Hussain MT. Comparison of fine needle aspiration cytology with excision biopsy of breast lump. J Coll Physicians Surg Pak 2005;15:211-4.  Back to cited text no. 10
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Khemkha A, Chakrabarti N, Shah S, Patel V. Palpable breast lumps: Fine needle aspiration cytology versus histopathology: A correlation of diagnostic accuracy. Internet J Surg 2009;18:1.  Back to cited text no. 11
    
12.
Ballo MS, Sneige N. Can core needle biopsy replace fine-needle aspiration cytology in the diagnosis of palpable breast carcinoma: A comparative study of 124 women. Cancer 1996;78:773-7.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12], [Figure 13], [Figure 14], [Figure 15], [Figure 16], [Figure 17]
 
 
    Tables

  [Table 1], [Table 2]



 

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