CYTOLOGICAL PROFILE OF VARIOUS BREAST LESIONS WITH SPECIAL REFERENCE TO BREAST CARCINOMA AND ITS CORRELATION WITH ER & PR STATUS: A PROSPECTIVE ANALYSIS OF 192 CASES.

Dr. Deepika Gupta*, Dr. Namita Bhutani and Dr. Moushmi Mukherjee

ABSTRACT

Background: Breast lumps constitute a significant proportion of surgical cases in women of both developed and developing countries. The aim of this study is to look the frequency distribution of various breast lesions on fine needle aspiration (FNA) with special reference to breast carcinoma and its correlation with ER and PR status. Materials and Methods: The 192 patients who presented with palpable breast lump, irrespective of age and sex were included in the study. Frequency distribution of various breast lesions with respect to age and sex was studied. Cytology grading in breast carcinoma was correlated in 20 cases with histology grading and its ER, PR status. Results: The majority (N = 184) of patients were females with maximum (N = 101) patients between third and fourth decade. The 154 patients had benign breast lesions and maximum patients were in the second decade. Fibroadenoma was the commonest benign lesion followed by fibrocystic change and mastitis. Out of 35 malignant breast lesions, 45.4% [N = 15] were between 41-50 years of age, 27.2% [N = 9] in 51-60 years and 15.1% [N= 5] in between 31-40 years of age. Out of 35 malignant breast lumps and majority were infiltrating ductal carcinoma (N = 33). Cytology grading correlated maximum with histology grade in Grade I followed by Grade II and Grade III and correlation with ER and PR status was also done. Conclusion: With experienced hands, FNA is safe, cost effective and a reliable technique for preoperative evaluation of palpable breast lumps. FNA features are more informative when combined with physical and radiology findings (Triple test). Fibroadenoma, fibrocystic change and mastitis form the major bulk of benign breast lesions. Epithelioid cells when seen in inflammatory breast FNA smears, tuberculosis must be ruled out. In India, breast carcinoma arises in younger patients as compared to western countries. Cytological Grading of breast carcinomas must be done on FNA smears for selecting neoadjuvent therapy. Prognostic factors like tumor size, expression of estrogen, progesterone receptors should be considered. Clinical breast examination and mammography screening in females should be encouraged in developing countries from the third decade onwards for early detection of breast carcinoma.

Keywords: Breast, benign, cytology, FNA, grading, malignant.