Comparison of fine needle aspiration cytology and fine needle sampling without aspiration in the diagnosis of palpable breast lumps in mulago hospital.

Abstract

INTRODUCTION: Open biopsy of the breast used to be the main traditional method of diagnosis of breast lumps. This was traumatic and done under anaesthesia. In 1021, fine needle biopsy (FNB) was introduced by Guthrie in the United States to diagnose cancer. It is now used worldwide. The techniques of FNB are; fine needle aspiration cytology (FNAC) and fine needle sampling (FNS) without aspiration. FNAC is the technique used in mulago hospital. Various studies have shown that FNAC technique depends on sanction and thus, yields hemorrhagic material for cytology study, is painful, is many times traumatic and results in haematoma formation. Furthermore, patients are apprehensive because of the needle mounted on the syringe unlike FNS without aspiration. FNS has been performed on various masses (Ear, Nose and Throat lymph node and thyroid lesions) with good diagnostic accuracy of 95.7%, 95.3% and 90%, respectively. However, for breast masses, no adequate studies have been documented as regards the use of FNS. This study was undertaken to find out if there is a difference in diagnostic accuracy in using FNAC and FNS without aspiration in the diagnosis of palpable breast lumps in mulago hospital. OBJECTIVE: To determine if there is a difference in diagnostic accuracy in using FNS and FNAC in patients with palpable breast lumps undergoing breast biopsy in mulago hospital. METHODS: This was a cross-sectional study conducted between October 2008 and January 2009 in the breast clinical surgical outpatients department (SOPD) of mulago national referral and teaching hospital, kampala-uganda. A total of 110 women with age range 16 years to 53 years, with average age of 21.7% years with palpable breast mass of 2cm and above (in the widest diameter by ultrasound) were subjected to FNS, FNAC and excision biopsy of the lump or mastectomy where appropriate after consent. Cyto diagnoses of all the cases were compared to the histo diagnoses of the biopsies to establish the sensitivity, specificity and diagnostic accuracy. Patients were excluded if they had breast lumps less than 2cm (in the widest diameter by ultrasound), refuse to have FNS, FNAC and excision biopsy and also those very sick (ASA III and above). Data was collected using questionnaires and analyzed using Epi info 6, STATA statistical package and presented informs of tables. Statistical data analysis was performed with Chi test where appropriate. Statistical significance was determined at p<0.05.

RESULTS: A total of 180 patients with complaints related to the breast were seen. Out of 180 patients, 70 patients were screened out of the study hence 110 patients enrolled into the study. The eligible patients provided consent, 10 patients were excluded (patients had breast lumps less than 2cm in the widest diameter on ultrasound) and finally 100 patients were recruited into the study. The 100 patients were subjected to both FNS and FNAC, 15 patients were dropped-out because they failed to return for excision biopsy. Finally, a total of 85 patients had FNS, FNAC and excision biopsy/ mastectomy done and these 85 patients were analyzed. The study findings demonstrated that both FNS and FNAC have the same sensitivity of 83.3%, specificity of 100% and diagnostic accuracy of 98.7% in the diagnosis of palpable breast lumps. The study also demonstrated that FNS had good quality smears in 88.2% of the patients as compared to FNAC smears which was 58.8% of the patients. The FNS smears were adequate in 95.3% of the patients as compared to FNAC smears which was adequate in 90.6% of the patients. CONCLUSION: There is no difference in the diagnostic accuracy of FNS and FNAC in the diagnosis of palpable breast lumps. These findings may suggest that it is probably the adequacy of the cells harvested rather than the quality of the cells harvested which determines the difference in the diagnostic accuracy of the two techniques.