A Comparative Study Between Fine-Needle Aspiration Cytology and Core Needle Biopsy in Diagnosing Clinically Palpable Breast Lumps

Abstract

Background and objectiveMost breast diseases present as palpable lumps. The accuracy of their diagnosis can be enhanced by a combination of clinical examination, mammography, fine-needle aspiration cytology (FNAC), and core needle biopsy (CNB) preoperatively. The ultimate aim of FNAC or CNB of the breast mass is to confirm the diagnosis of cancer preoperatively, which may help avoid unnecessary surgeries for benign conditions. Histopathology is the gold standard to establish the diagnosis of a breast mass. In this study, we aimed to compare the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of FNAC with those of trucut biopsy, and provide a combined assessment of FNAC and CNB against the final histopathological diagnosis of excised breast mass in suspected breast malignancies. Materials and methodsThis was a prospective, observational, cross-sectional study conducted for a duration of one year involving 42 patients with suspected breast cancer cases who underwent FNAC, CNB, and surgical excision followed by a histopathological examination. Data were collected and analyzed in terms of sensitivity, specificity, PPV, NPV, and diagnostic accuracy of FNAC and CNB in comparison with histopathology. ResultsThe majority of the patients in the study (78.6%) were in the age group of 31-50 years. In our study, FNAC showed a sensitivity, specificity, PPV, NPV, and diagnostic accuracy of 74.1%, 76.9%, 87.0%, 64.7%, and 75% respectively. CNB had a sensitivity, specificity, PPV, NPV, and diagnostic accuracy of 85.2%, 92.8%, 95.8%, 76.5%, and 87.8% respectively. The level of agreement between the two modalities (FNAC and CNB) was moderate and statistically significant (k=0.543; p<0.001). In the combined assessment of FNAC and CNB against final histopathological diagnosis for malignancy/borderline diagnosis, the sensitivity, specificity, PPV, NPV, and diagnostic accuracy were 89.3%, 85.7%, 92.6%, 80%, and 88.1% respectively. ConclusionThe diagnostic accuracy of the combined assessment of FNAC and CNB against final histopathological diagnosis for malignancy/borderline diagnosis was better than that of FNAC or CNB alone. This finding shows that both the techniques complement each other. FNAC and CNB are used as the first-and secondline methods of pathological diagnosis respectively.

Cytological Evaluation of Fine Needle Aspiration of Breast Lesions Using IAC Yokohama Classification System for Reporting Breast Cytopathology

“…The output for patients depends upon histopathology laboratories vary between those countries with well-developed medical infrastructure and those low-and middle-income countries with more limited resources. Finally, the IAC Yokohama System will invoke a response from the cytology community and also from all those who provide a component in [6] Kamatar et al [4] Malvina D and Reshma G [10] Oosthuizen et al [11] Nigan et al [7] Present the "triple" diagnostic approach, which is the best practice for women with breast lesions. This will lead to continuing improvements in the care of patients with breast lesions and possible modifications to the IAC Yokohama System.…”

“…Agarwal et al [3] Kamatar et al [4] De Rosa et al [5] Montezuma et al [6] Nigam JS et al [7] Present this disconcordance due to the nature of lesion of being showing low cellularity in a hemorrhagic background containing mucinous material also the younger age group of patients might have biased the cytological diagnoses. Based upon the findings and taking Yokohama categories I, II and III as benign and categories IV and V as malignant for statistical evaluation we calculated sensitivity as 74.07%, specificity and PPV as100%, NPV as 86% and diagnostic accuracy as 90%.…”

“…International Academy of Cytology (IAC) Yokohama system for reporting breast cytopathology, further aids to the diagnosing capacity of FNAC by classifying the breast lesions in different categories provided with a probable management option along with acceptable precalculated Risk Of Malignancy (ROM) [4][5][6] . IAC Yokohama system provide better communication between the surgeon and the pathologist, hence improves the reproducibility of cytopathological reporting of breast lesions [2] .Histopathological examination is considered the gold standard for diagnosing benign as well as malignant breast lesions [7,8] .…”

Ultrasound-Guided Intervention for Breast Lesions

“…코어침 생검은 진공 보조 생검이나 수술적 절제 생검에 비해 수월하고 안전하면서 세침흡인술보다 많은 양의 조직을 얻을 수 있어 병변의 악성과 양성 병변 감별 진단에 세침흡인술보다 진단의 정확도가 높고, 조직을 얻을 수 있으므로 좀 더 구체적이고 자세한 병리학적 진단이 가능하다( 5 6 ). 조직을 얻을 때에는 검사하고자 하는 병변에 대해 적어도 네 군데 이상 바늘을 통과시켜서 샘플을 얻는 것이 추천되는데, 한 병변에서 4회 이상 서로 다른 부위를 생검할 때의 정확도는 100%까지 보고되고 있다( 7 ).…”

Assessment of Specificity and Sensitivity of Tru-Cut Biopsy as Compared With Postoperative Histopathological Results in Young Females With Breast Mass

“…In recent years, FNAC and CNB have emerged as highly effective diagnostic techniques for assessing palpable breast masses. [6] Tru-cut biopsy, also known as a core needle biopsy, is a significant approach for obtaining a histological diagnosis today (CNB). It is straightforward and can be done as an outpatient procedure.…”