Diagnostic Accuracy of Fine Needle Aspiration Cytology in Diagnosis of Breast Lump in Surin Hospital
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Abstract
Background: Fine needle aspiration cytology is a part of triple assessment of breast lesions, including clinical breast examination, imaging studies (Mammogram and Ultrasound) and pathological diagnosis (Fine needle aspiration cytology: FNAC or Core needle biopsy: CNB). It has an important role as a guide to preoperative decision and management. It is useful due to fast turnaround time, high accuracy, cost efficiency, and minimal invasive procedure.
Objective: The aim of this study was to evaluate the accuracy of fine needle aspiration cytology (FNAC) compared with histology of breast lumps and was to determine factors affecting the discordant diagnosis between cytology and histology.
Materials and Methods: The study was a cross-sectional study by collecting data in patients with breast lumps and underwent a cytological diagnosis with fine needle aspiration cytology (FNAC) followed by a histology in the same lesion in Surin Hospiral from 1st January 2012 to 31st December 2020. FNAC were reported based on The International Academy of Cytology Yokohama System for Reporting Breast Fine-Needle Aspiration Biopsy Cytopathology. The numbers of cytological specimens were 485 cases; which remained 373 cases from 342 patients after unsatisfactory samples were excluded. For calculating, categories of C2 and C3 were reclassified as benign diagnoses while C4 and C5 were reclassified as malignant diagnoses. The quantitative data were analyzed by using the statistical analysis software (STATA) and using Generalized Estimating Equations (GEE) method. Data were evaluated the likelihood ratio and were calculated accuracy, sensitivity, specificity, positive predictive value, negative predictive value, false positive and false negative. The relationships of factors affecting the discordant diagnosis were also described.
Results: A series of 373 cases revealed benign lesions (C2) in 274 cases (73.5%), atypical lesions (C3) in 5 cases (1.3%), suspicious for malignancy (C4) in 20 cases (5.4%) and malignant (C5) in 74 cases (19.8%). The present study showed sensitivity, specificity, PPV, NPV and accuracy of 90.3%, 99.6%, 98.9%, 96.4% and 97.1%, respectively. False positive and false negative were 0.3% and 2.7%, respectively. FNAC likelihood ratio for malignant of the benign diagnosis was 0.10 (95% CI, 0.06-0.18), of the atypical diagnosis was 0, of the suspicious favor malignant diagnosis was 49.81(95% CI, 6.75-367.31), and of the malignant was not applicable. There were 11 cases in cytohistological discordance; occurred significantly in older patients (52.8±13.8 years compared with 38.7 ± 15 years, OR=1.06,95% CI (1.03-1.11), p<0.001), correlated with breast lumps containing cysts (OR=4.76 95% CI (1.31-17.25), p=0.018) and occurred in case of technical problems; including limited cellularity and slide preparation (OR=10.09, 95% CI(2.61-39.00), p<0.001 and OR=22.42,95% CI (3.50-143.57), p<0.001).
Conclusion: FNAC is still accurate for the diagnosis of breast lumps. However, the interpretation may be restricted in some conditions; breast lumps with cystic components, technical problems (limitation of cellularity and slide preparation) and specimens collecting from elderly patients, leading to cytohistological discordance. The triple assessment including physical examination, pathological assessment, and imaging studies are recommended to maximize accurate diagnosis.
Keywords: Fine-Needle Aspiration Cytology, Triple Assessment, Accuracy, Discordant
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References
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