Fine needle aspiration cytology in young women with breast cancer: diagnostic difficulties
ABSTRACT Breast carcinoma is the most common malignancy in women worldwide. Though fine needle aspiration cytology (FNAC) plays an important role in preoperative diagnosis, there may be diagnostic delays in affected young women due to a lower index of suspicion.
The files of the Departments of Pathology, Singapore General Hospital, Singapore, and Prince of Wales Hospital, Hong Kong, were searched for cases of breast carcinoma in women aged 35 years or less. Those with prior FNA procedures comprised our study group. The FNA smears were reviewed and classified into five categories: inadequate, benign, equivocal, suspicious, malignant. The findings were correlated with subsequent histology.
Thirty-four women aged 35 years and below underwent 35 FNACs, with one woman having bilateral FNA procedures. Upon review, one (2.9%) was classified as inadequate, one (2.9%) benign, five (14.3%) equivocal, five (14.3%) suspicious, 21 (60%) malignant and slides were not available for review for two (5.6%) cases. For six benign and equivocal cytological diagnoses, subsequent histology disclosed pure ductal carcinoma in situ (DCIS, 1 case), mucocoele-like lesions with DCIS (2 cases), invasive and in situ ductal carcinoma with neuroendocrine features (1 case) and two cases of invasive ductal carcinoma.
Diagnostic difficulties in cytological interpretation of aspirates from breast carcinoma in young women may lead to unwanted delays, which occurred in six (17.6%) of 34 women in our series. Low grade cancers posing a pitfall in cytological diagnosis have to be considered.
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ABSTRACT: Fine-needle aspiration biopsy (FNAB) of the breast is a minimally invasive yet maximally diagnostic method. However, the clinical use of FNAB has been questioned. The purpose of our study was to establish the overall value of FNAC in the diagnosis of breast lesions. After a review and quality assessment of 46 studies, sensitivity, specificity and other measures of accuracy of FNAB for evaluating breast lesions were pooled using random-effects models. Summary receiver operating characteristic curves were used to summarize overall accuracy. The sensitivity and specificity for the studies data (included unsatisfactory samples) and underestimation rate of unsatisfactory samples were also calculated. The summary estimates for FNAB in diagnosis of breast carcinoma were as follows (unsatisfactory samples was temporarily exluded): sensitivity, 0.927 (95% confidence interval [CI], 0.921 to 0.933); specificity, 0.948 (95% CI, 0.943 to 0.952); positive likelihood ratio, 25.72 (95% CI, 17.35 to 28.13); negative likelihood ratio, 0.08 (95% CI, 0.06 to 0.11); diagnostic odds ratio, 429.73 (95% CI, 241.75 to 763.87); The pooled sensitivity and specificity for 11 studies, which reported unsatisfactory samples (unsatisfactory samples was considered to be positive in this classification) were 0.920 (95% CI, 0.906 to 0.933) and 0.768 (95% CI, 0.751 to 0.784) respectively. The pooled proportion of unsatisfactory samples that were subsequently upgraded to various grade cancers was 27.5% (95% CI, 0.221 to 0.296). FNAB is an accurate biopsy for evaluating breast malignancy if rigorous criteria are used. With regard to unsatisfactory samples, futher invasive procedures are required in order to minimize the chance of a missed diagnosis of breast cancer.BMC Cancer 01/2012; 12:41. DOI:10.1186/1471-2407-12-41 · 3.32 Impact Factor
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ABSTRACT: Patients with breast-problems make up a major part of the patient load at a general surgical out-patients' clinics. Majority of patients correlates breast pain with breast cancer. Virtually, every women with a breast lump, breast pain or discharge from nipple fears that she has breast-cancer. The anxiety that result is made Abstract: A prospective type of analytical study was carried out on 106 patients with breast pain to analyze the causes of breast pain. This study was conducted from August, 2002 to January 2004 at breast clinic of Bangladesh Medical College Hospital (BMCH) and at Department of Surgery of BMCH. Sampling was done purposively and a structured questionnaire was used for data collection by interviewing followed by examining the patient in the first phase. In the second phase, Mammography and FNAC (Fine Needle Aspiration Cytology) was done. Majority of the patients (35.8%) were in the age group of 21- 30 years and the mean age was 27.61± SD10.5 years. About 48.1% breast pains were due to ANDI (Aberration of Normal Development and Involution) and among the other causes nonspecific pain 15.1%, breast abscess 14.2% and carcinoma of breast were only 1.9%. The performance status of all the patients were in between 0- 1. Mammography was done in 54 patients and of them 44 was found positive for fibrocystic disease (41 cases) and fibroadenoma (3 cases). FNAC was done in 50 patients and 36 were found positive with fibroadenoma (22 cases), fibrocystic change (8 cases), chronic breast abscess (2 cases), mitotic lesion (2 cases), and neurofibroma (2 cases). So painful breast diseases are helpful in seeking further medical care for appropriate intervention