Cytopathology

Biography

Biography: Ahmed El-Habashi

Abstract

Background: Fine-needle aspiration cytology (FNAC) has proven to be valuable tool in the primary diagnosis and management triage of patients with breast lesions. Objectives: This study aimed at evaluation of diagnostic utility of FNAC in breast lesions with an emphasis on potential cytological pitfalls that might lead to erroneous diagnoses. Methods: The study was carried out on 640 patients presented to breast clinic complaining of breast lumps. FNAC was performed after physical and radiological evaluation. The FNAC results were correlated with the available subsequent histological diagnoses and follow-up as a gold standard. The accuracy was calculated. The author discussed the cytologic pitfalls that may lead to “erroneous” false positive or false negative diagnoses. Results: The cytological diagnoses included unsatisfactory in 45 cases (7%), benign in 495 (78%), suspicious in 40 cases (6%) and malignant in 60 cases (9%). The potential causes of false positive diagnoses were fibroadenoma, Swiss cheese disease, lactating adenoma, Lactational mastitis, pregnancy changes, sclerosing adenosis, fat necrosis, ductectasia and others. The potential causes of false positive diagnoses were lobular carcinoma, mucinous carcinoma, adenoid cystic carcinoma, tubular carcinoma and proliferative changes with carcinoma transformation. The FNAC has achieved 94%, 100%, 100%, 98%, sensitivity, specificity, positive predictive value and negative predictive value, respectively, with an accuracy of 99%. Conclusions: This study confirmed the valuable diagnostic role of FNAC in management triage of patients with breast lumps. The diagnostic accuracy of this procedure can be significantly improved by acquiring a detailed clinico-radiologic data, obtaining an adequate specimen, having prior knowledge of the variety of diagnostic entities and strict application of established cytological criteria.