Palpable breast masses in a tertiary institution of South-South Nigeria; fine-needle aspiration cytology versus histopathology: A correlation of diagnostic accuracy

Abstract

Background and Objective: Fine-needle aspiration cytology (FNAC) of the breast, as part of the triple assessment approach to the diagnosis of palpable breast masses, has become a valuable preoperative tool. It is fast, inexpensive, and minimally invasive and thus has gained wide acceptance in the preoperative assessment of breast masses. This study aims to determine the diagnostic accuracy of FNAC of palpable breast masses in a tertiary hospital in Nigeria. Materials and Methods: This is a prospective comparative study comprising the reports of the FNAC of palpable breast masses and their subsequent tissue biopsy diagnoses recorded over 1 year from September 1, 2013, to August 31, 2014. Results: A total of 100 consecutive FNAC reports were made during the study period. There were 98 females (98%) and 2 males (2%). The age range of the patients was 18–65 years with a mean age of 42.5 years at presentation. On cytodiagnosis; 14 (14%) cases were inadequate samples (C1), 52 (52%) cases were benign (C2) lesions, 2 (2%) cases were suspicious probably benign (C3) lesions, 4 (4%) cases were suspicious probably malignant (C4) lesions, and 28 (28%) were malignant (C5) lesions. The cytology reports were correlated with the subsequent histological diagnoses. Of the 14 C1 reports, 13 were confirmed on tissue histology as benign lesions and the remaining 1 as malignant. Fifty-one of the 52 C2 reports were confirmed as truly benign (true negatives) and the remaining 1 as malignant (false negative). The overall suspicious rate (C3 and C4) was 6% with the 2 C2 reports confirmed as benign and 3 of the 4 C4 reports confirmed on histology as malignant. All 28 malignant (C5) reports were confirmed by tissue histology as malignant (true positive). The absolute sensitivity was 84.9%, complete sensitivity was 93.9%, specificity was 98.2%, positive predictive value (C5) was 100%, negative predictive value (C2) was 98.2%, false-negative rate was 3.0%, and suspicious rate was 4.3%. Conclusion: FNAC of palpable breast masses shows high sensitivity and specificity in our center. It is strongly recommended to be done on all patients presenting with palpable breast masses to ensure quicker pathologist–surgeon communication, patients' triage, and early establishment of definitive treatment outline.