Cytomorphologic Study of Breast Lesions: Spectrum of Lesions and Histopathological Correlation

Abstract

Introduction
Breast masses are a diagnostic dilemma in clinical practice, even if majority of them are benign. Hence, a reliable and rapid diagnostic modality is crucial in the management of breast lesions, and fine-needle aspiration cytology (FNAC) has been considered a 
reliable, rapid and economical method when combined with clinical and radiological findings, the triple test, to accurately diagnose 
palpable breast masses. It has an estimated sensitivity of 90-99% and a diagnostic accuracy of 96.2%.
Objectives
To describe cytomorphologic patterns of breast lesions and to determine diagnostic accuracy of FNAC.
Methods
A 3 year retrospective cross-sectional descriptive study was conducted. All patients who had breast FNAC from September 2019 
to August 2022 at pathology department of Jimma University Medical Centre (JUMC) and that fulfilled the eligibility criteria were 
selected along with their matching histopathology reports. The collected data was coded, cleaned, and entered into Epidata 3.1, 
then exported to SPSS v26 and analyzed. Descriptive analysis was done for frequency and distribution of the disease. The risk 
of malignancy (ROM) for each International Academy of Cytology (IAC) yokahama category was determined and diagnostic 
performance was evaluated based on a three-category approach.
Results
An increasing occurrence of malignant breast lesions was observed, from 21.7% in 2019/20 to 29.9% in 2021/22. The mean age 
was 41.4±13.38 and 28.7±11.3 for malignant and benign breast lesions respectively. The most common benign breast lesion was 
fibroadenoma 322 (38%) in females and gynecomastia 75 (87.2%) in males. The ROM for each category was for C1 66.6 %, C2 
0%, C3 30.5%, C4 54.5% and C5 98.7 %. The absolute sensitivity, complete sensitivity, specificity, PPV and NPV were 77.2%, 
100%, 99.1%, 98.7% and 100%, respectively. 
Conclusion
There is an increasing incidence of malignant breast lesions with majority of the cases occurring in younger patients. The higher 
sensitivity and specificity FNAC in diagnosing malignant lesions supports its use