ANALYSIS OF CORE NEEDLE BIOPSY VERSUS FINE NEEDLE ASPIRATION CYTOLOGY IN THE DIAGNOSTIC APPROACH OF PALPABLE BREAST MASS

Abstract

BACKGROUND:Breast cancer is one of the leading causes of death in women globally. Triple assessment was prompted worldwide which includes clinical (Palpation), radiological (Ultrasonography& Mammography) and cytological (Fine needle aspiration/ FNA/FNAC) assessment. But in recent times, there was a gradual increase in demand of core needle biopsy (CNB) instead of Fine needle aspiration as a tool for preoperative diagnosis of breast cancer. There are some major limitations of Fine needle aspiration like inability to pick up some borderline lesions such as atypical ductal hyperplasia, in situ carcinoma, and also it is quite difficult to distinguish these lesions from invasive carcinoma. In detection of such grey zone lesions of breast, Core needle biopsy has an edge over Fine needle aspiration cytology. In our study we will analyse the accuracy of FNAC and CNB in the diagnosis of breast masses preoperatively by comparing the diagnoses of respective post operative excision samples.
AIM AND OBJECTIVE:
1. To analyse primary diagnosis of breast lump by FNAC and CNB
2. To assess the diagnostic accuracy of each of the method by comparingthe resultswith respective post operative histopathology report.

PATIENTS AND METHODS:The current prospective study was conducted on the patient attending cytology section of the department of Pathology MKCG Medical college Berhampur, Odisha for evaluation of breast mass aspiration fromJanuary 2023 to June 2024(18 months). Total 92 patients were included in the study. Informed consent of patients wastaken. Then the patients were subjected to FNA using 5/10 cc syringes and 22/23 G needles under local anaesthesia. Simultaneously CNB specimens were also taken by 14gz 10 cm biopsyneedle. Cytosmear were stained with May–Grunwald Giemsa, diff Quick,haematoxylinand eosin and pap. The post operative excision biopsy (EB) specimenwas subjected to processing and microsection were studied with haematoxylin and eosin stain. The preoperative FNACand CNB diagnoses results were compared with post –operative excisional biopsy specimens results.
INCLUSION CRITERIA
1. All patient with clinically palpable breast lump.
EXCLUSION CRITERIA
1. Patients not giving consent.
2 . Patients who were under chemotherapy and radiotherapy.
3 . Acute suppurative lesion or breast abscess diagnosed on cytology.
4 .Patient with bleeding disorder.
RESULTS: Total of 92 cases were studied within the age group of 19-77 years. In this study FNAC was found to have, sensitivity of 95%, specificity of100%, PPV of 100%, NPV of 75% and accuracy of 95.6%. In comparison to FNAC, CNB showed a sensitivity of 97.5%, specificity of 100%, PPV of 100%, NPV of 87% and accuracy of 97.8%.

CONCLUSION: CNB has high sensitivity and specificity in detecting malignant lesion compared to FNAC. CNB always provides definitive histopathological diagnosis along with information regarding tumour type, grade, hormonal receptor status of tumour that permits the eventual use of neo-adjuvant therapy, which helps in planning the appropriate treatment for the patient and also avoids unnecessary excisional biopsy. CNB is cost effective and has minimal complications compared to excision biopsy. If the initial FNAC is inadequate, core needle biopsy (CNB) can be a useful second line method of pathological diagnosis in order to minimize the chance of missed diagnosis of breast cancer. Therefore, it is concluded that, CNB is better than FNAC in evaluating breast lump.