Arunraja, K K (2020) A Comparative study between FNAC, Trucut Biopsy and Histopathological Examination in Breast Lumps in Tirunelveli Medical College Hospital, Tirunelveli. Masters thesis, Tirunelveli Medical College, Tirunelveli.
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Abstract
BACKGROUND: For patients with visible breast lump in the outpatient unit, a method of definitive diagnosis is necessary. The procedure must be precise, easy to perform and acceptable to the patient, healthy, can be done in a busy clinic setting and must not require too much planning or expensive equipment. A study was conducted to compare the diagnostic accuracy of Fine Needle Aspiration Cytology (FNAC) and Tru-cut Biopsy to distinguish between benign and malignant breast lump lesions. OBJECTIVES: 1. To compare the diagnostic accuracy of fine needle aspiration cytology and tru-cut biopsy in differentiating benign and malignant lesion of palpable lump in breast with cytological and histopathological correlation. 2. To analyze the sensitivity, specificity, positive and negative predictive values and the efficacy of fine needle aspiration cytology and tru-cut biopsy. METHODS: A prospective study on breast aspirates and biopsy was done over an 18- month period from September 2017 to May 2019. All patients presenting with palpable breast lesions to the Department of General Surgery OPD, Tirunelveli Medical College Hospital were subjected to FNAC procedure after a detailed history, general physical and local examination and the results of 295 cases were categorized. Subsequent to the reporting, the patients are subjected to tru-cut biopsy with histopathological correlation. Cytology reporting was compared with histopathological report to determine its diagnostic accuracy. Using the Scarff Bloom Richardson grading system, histological grading was done. The results of aspiration cytology and the results of tru-cut biopsy are combined with the final histopathological study to determine how reliable the cytology of fine needle aspiration was relative to tru-cut biopsy when determining the cytohistological connection RESULTS: The age range of the selected patients in our study, range from 14 years to 80 years and the most common age group having benign breast lump is 21 – 30 years and that of malignant breast lump is 41 – 50 years of age. The most common benign pathology encountered among the patients in our study was fibroadenoma among (94 patients). Of the total 170 patients of histologically proven malignancy, FNAC had reported 153 malignant, 17 cases as false negative cases. There were zero false positive cases. Analysis of tru-cut biopsy reports revealed higher diagnostic accuracy. Out of the 295 patients who were studied, Trucut biopsy 131 patients as benign lesions, 125 were confirmed to have benign lesion. Tru-cut had reported 164 malignant, 6 cases as false negative cases. The Accuracy rate for diagnosing malignant lesions by FNAC is 94.24 % and the unsatisfactory specimen rate is 1.01%. The overall sensitivity of FNAC in diagnosing a malignant lesion in this study was 90.00%, and specificity was 100.00%. Accuracy rate for diagnosing malignant lesions by Tru-cut is 97.97%. Unsatisfactory specimen rate is 1.35%. The overall sensitivity of trucut in diagnosing a malignant breast lesion in our study was 96.47%, specificity was 100%. The positive predictive value of FNAC to diagnose a malignant breast lesion was 100.00% and negative predictive value was 88.03% in this study. The positive predictive value of tru-cut biopsy in diagnosing a malignant breast lesion in our study was 100.00% and negative predictive value was 95.42%. Based on Robinson grading system the cases were classified into grade I (14%), grade II (52%) and grade III (34%). Based on Scarff Bloom Richardson grading method the cases were classified into grade I (6%), grade II (55%) and grade III (39%). Spearman’s correlation coefficient of 0.5 was calculated which indicated positive correlation between the two grading systems. CONCLUSION: Fine needle aspiration cytology (FNAC) is a rapid, less complicated, economical, reliable and relevant method for the preoperative pathological diagnosis of breast lump Trucut biopsy was able to give histological diagnosis and results correlated 100% with the final histopathological report. It also gives further information about tumor type, grade, lympho vascular invasion and receptor status. The diagnostic efficacy, sensitivity and specificity observed by FNAC in this study was comparable to that observed in Tru-cut biopsy and other texts. Therefore, in the preoperative diagnosis of both benign and malignant lesions, FNAC stands as an effective and valid tool as the first line diagnostic method.
| Item Type: | Thesis (Masters) |
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| Additional Information: | 221711352 |
| Uncontrolled Keywords: | FNAC, Tru-cut, Histopathological Examination, Breast Lumps. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Subramani R |
| Date Deposited: | 11 Feb 2021 01:22 |
| Last Modified: | 11 Feb 2021 01:22 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/14031 |
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