A correlative study of FNAC, excision biopsy and final diagnosis in benign and malignant breast lumps

Sanjeev Pandian, R (2006) A correlative study of FNAC, excision biopsy and final diagnosis in benign and malignant breast lumps. Masters thesis, Tirunelveli Medical College, Tirunelveli.


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INTRODUCTION: Fine-needle aspiration cytology (FNAC) was performed on a large scale at Memorial Hospital, New York, during the 1930s, but during the ensuing years, it did not gain much encouragement in United States. The technique had a resurgence in Scandinavia during the 1950s and 1960s, where it flourished before spreading to other parts of the world. For decades, small samples of tissue have been obtained using a needle to diagnose lesions in many anatomical locations. Breast lesions were identified as particularly suitable for the technique due to their accessibility. The use of smears obtained by aspiration for diagnostic purposes was reported as early as 1933, when Stewart’s series of 2,500 specimens included almost 500 breast lesions. The publication of cytology results for a series of 2, 111 fine needle aspiration (FNA) samples by Franzen and Zajicek in 1968 established the technique as a vital part of the assessment of breast lesions. FNA cytology and core biopsy were originally used to diagnose palpable breast lesions. Both methods have a high degree of sensitivity and specificity. FNA cytology is an excellent method for diagnosing palpable lesions; its sensitivity has been reported to be between 89% and 98%5 and its specificity between 98% and 100%. Following the introduction of mammographic screening, FNA cytology is now also used to diagnose impalpable breast lesions. The sensitivity and specificity of stereotactic FNA cytology with impalpable lesions have been reported to be 77–100% and 91–100% respectively. AIMS AND OBJECTIVES: 1. To study the Epidemology of breast disorders in Tirunelveli Medical College Hospital. 2. To assess the value of FNAC in the preoperative evaluation of patients 3. To correlate the findings of FNAC with that of HPE of the excised speciment after surgery. 4. To determine the incidence of malignancy and other Benign lesions of the Breast. 5. The diagnosis of Carcinoma of Breast. 6. The diagnosis of Fibro Cystic Diseases, Which in most cases can be managed medically without the need for surgery. 7. The avoidance of surgery in Doubtful cases where there is no pressing need for operative intervention based on a firm tissue diagnosis. 8. To recognise early breast cancers where there is scope for breast conservation surgery. 9. To analyse the cost-effectiveness of FNAC. METHODS, MATERIALS AND TECHNIQUES: THE TRIPLE TEST: FNA cytology should always be interpreted in the context of the triple test. The triple test is the recommended approach for the investigation of palpable or impalpable breast lesions detected by imaging. It comprises the following components: • Clinical breast examination and medical history • Imaging – mammography and/or ultrasound • Non-excision biopsy – FNA cytology and/or core biopsy. The triple test is positive if any of the three components is positive, and negative if all the components are negative.The triple test has a sensitivity (truepositive rate) of 99.6%, and a specificity of 93%. Irwig and Macaskill (1997) have developed models to illustrate the accuracy of the triple test results for clinically and mammographically detected breast lesions. The aims of the triple test are to: • Maximise the diagnostic accuracy in breast disease. • Maximise the preoperative diagnosis of cancer. • Minimise the proportion of excision biopsies for diagnostic purposes. • Minimise the proportion of benign excision biopsies for diagnostic purposes. OBSERVATION AND RESULTS: “The only function of FNAC is to differentiate neoplastic from non neoplastic tissue” this statement by FERGUSSEN in 1937 may still be valid. 289 patients was enrolled for this study , conducted between July 2003 to February 2006. The age group of patients selected for this study ranged from 15 years to 88 years. Epidemology of Breast Disorders in Tirunelveli Medical College Hospital: The total number of Female Inpatients during the period of this study was 53,723. The percentage of Female Inpatients with Breast disorders (261) in TVMCH during this study period was 0.48 %. The Percentage of female inpatients having Breast cancer (134) during this study period was 0.249 %. Total number of major cases performed in surgery dept during this study period was 19,312.The Percentage of Breast surgeries (289) in TVMCH during this study period was 1.49 %. Out of the 289 patients 28 patients were male. TABLE I and TABLE 11 shows distribution of patients according to their sex and age. The 289 patients selected were clinically examined, investigated, diagnosed and was subsequently operated upon. TABLE 1V shows the distribution of patients according to their preoperative FNAC diagnosis. FNAC was done for all the 289 patients. All the patients enrolled in this study were in-patients and all the patients were followed up, during surgery and after discharge, and their HPE reports were collected by me personally. All the 289 patients readily agreed for the procedure, after proper explanation. Patients showing acellular smear or paucicellular smear were subjected to repeat FNAC. CONCLUSION: The following conclusions were drawn from this study, The Percentage of Female Inpatients with Breast disorders (261) in TVMCH during this study period was 0.48 %. • The Percentage of female inpatients in TVMCH having Breast cancer (134) during this study period was 0.249 %. • Breast surgeries made up 1.49 % of all the major surgeries performed in TVMCH during this study period. 1. The over all accuracy rate of FNAC was 87.92% and it reliably helped to plan the nature of Surgery to be undertaken. With Experience and use of Guidance techniques, the accuracy rate can be Improved to 94-96% at par with current international standards. 2. The sensitivity of this study was 96.26 % for Breast malignancy, and 95.32 % for benign breast disorders. 3. FNAC can reliably diagnose Fibro Cystic disease and Surgery can be avoided for those patients. The 9 patients with FCD operated in this study had a Dominant, Symptomatic and Chronic lump, refractory to medical management. 4. The predictive value of a Positive test for Malignancy was 96.26 % in this study. 5. FNAC was reliable in diagnosing recurrent tumors and Metastatic nodes. 6. Preoperative FNAC report and clinical diagnosis were both correlated before planning a Mastectomy and was Justified in all the patients who underwent Mastectomy. 7. There were no False positive cases this study. 8. FNAC was less accurate in diagnosising & confirming Medullary Carcinoma (50 %), Gynaecomastia (92.3 %) and Phyllodes (90.9 %). With experience and guidance techniques, there results can no doubt be improved upon. 9. FNAC can aid in the follow up of patients, with the least incidence of complication. In this study, there was a only a single case of Haematoma after FNAC in a case of Advanced IDC. 10. There were totally 4 False Negative cases and most of then were due to sampling error, which can be brought down by experience. 11. Females obviously dominated the study with maximum incidence of breast tumors in the 20 to 60 years age group. 12. In 1933, STEWART stated that “diagnosis by aspiration is as reliable as the combined intelligence of the clinician and pathologist ,make it”. This wise euphorism holds good for any study, and will influence the outcome of any study.

Item Type: Thesis (Masters)
Uncontrolled Keywords: FNAC ; excision biopsy ; final diagnosis ; benign and malignant breast lumps ; correlative study.
Subjects: MEDICAL > General Surgery
Depositing User: Subramani R
Date Deposited: 12 Oct 2017 01:02
Last Modified: 09 Jun 2018 16:45
URI: http://repository-tnmgrmu.ac.in/id/eprint/3554

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