Comparison of Grading and ER, PR Hormone Receptor Status of Carcinoma Breast in FNAC with Histopathology - A Cross Sectional Study from Thrissur, Kerala

Abstract

BACKGROUND Breast cancer is now the most common cancer in cities in India and 2 nd most common cancer in the rural areas. Fine needle aspiration cytology (FNAC) is a less invasive pre-operative diagnostic method and is preferred over core / excision biopsy to decide the benign or malignant nature of the breast lump. Prognostic factor assessment by FNAC would allow the identification of patients who would benefit from neo adjuvant treatment (patients with grade 3 tumours) and in whom conservation surgery is inadvisable.1 The purpose of this study is to compare the grades of breast cancer in FNAC with histopathology as gold standard and compare the oestrogen (ER) and progesterone (PR) hormonal expression pattern on immunocytochemistry (ICC) with immunohistochemistry (IHC). From this study we intend to assess the usefulness of cytological grading and ER, PR hormone receptor status pre-operatively so that hormonal therapy can be included with neoadjuvant chemotherapy. METHODS This is a cross sectional study with a sample size of 50, conducted in the Department of Pathology. RESULTS Out of 50 cases, maximum number of patients were in the age group of 51 - 60 years. 68 % had attained menopause; 69 % of patients had tumour size between 2 - 5 cm and 90 % of tumours were in the upper outer quadrant of breast. Considering hormonal expression, in case of ER there was a moderate agreement between ICC and IHC (κ = .428, P = 0.005) and no agreement was seen in case of PR (κ = .073, P = 0.625). Regarding the cytological grading, this study showed highest degree of concordance with grade II tumours with a sensitivity of 75.9 %. For Grade I it was 2.5 % and for grade III, it was 33.3 %. CONCLUSIONS Evaluation of hormonal status and nuclear grading is fairly reliable on cytology when performed on qualitatively superior FNAC material from the primary breast lesions. KEYWORDS Carcinoma Breast, FNAC, ER / PR, Immunocytochemistry, Immunohistochemistry, Cytological Nuclear Grading