Choosing between FNAC and Core Needle Biopsy: A Battle in Breast Carcinoma Diagnosis | Chapter 5 | Advancement and New Understanding in Medical Science Vol. 6

The present study was conducted in a tertiary care teaching hospital to evaluate the role of FNAC and CNB in diagnosis of suspicious breast cancer by keeping mastectomies- surgical excision (SE) as gold standard. Breast cancer is the commonest female malignancy worldwide. The management of breast carcinoma relies heavily on the diagnostic parameters. Over the years there has been a steady decline in the usage of fine needle aspiration cytology (FNAC) over more popular core needle biopsy (CNB). This was a prospective study done in the department of Pathology of a tertiary care teaching hospital catering to the urban as well as rural population in northern part of India. A total of 60 patients were subjected to simultaneous on site FNAC and CNB. Histopathological correlation (SE) was available in half of the cases only (30 cases). While the Cytological grading was done according to Robinson grading system; the histopathological grading was done by Nottingham Modification of Scarff-Bloom Richardson method. FNAC diagnosed 29 cases whereas CNB diagnosed only 26 cases as malignant with 3 cases signed out as non-diagnostic for malignancy owing to non-sampling from the representative areas. On comparing, FNAC and CNB; agreement was not statistically significant (p=0.14) Comparison of CNB and SE; in 17 cases agreement were noted for both CNB and SE and statistically the values were highly significant (p=0.0001). On comparison of FNAC and SE in 13 cases agreement was noted for both FNAC and SE and the data was statistically significant (p=0.035). It is concluded that FNAC gives 100% results, it is quite reliable investigation and CNB should be done as an adjunct if needed especially for grading of the tumor and for immunohistochemistry.

Author(s) Details:

Parul Garg,
Department of Immunohematology and Blood Transfusion, GGS Medical College and Hospital, Faridkot, India.

Harjot Kaur,
Department of Pathology, SGRDIMSR, Sri Amritsar, India.

Neetu Kukar,
Department of Immunohematology and Blood Transfusion, GGS Medical College and Hospital, Faridkot, India.

Ishwer Tayal,
Department of Forensic Medicine and Toxicology, GGS Medical College and Hospital, Faridkot, India.

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Significance of Tissue Microbiopsies in Fine Needle Aspiration Cytology- A Prospective Study | Chapter 18 | Recent Developments in Medicine and Medical Research Vol. 9

 Background: Fine needle aspiration cytology is an indispensable tool for both pre-therapeutic inquiry and recurrence diagnosis. The importance of fine needle aspiration cytology (FNAC) in the diagnosis of malignant tumours has been documented. However, a definite diagnosis based solely on FNAC is not always attainable. In routinely analysed FNA smears, there are some difficulties. They often have a very small amount of tissue material, and the lack of discernible tissue architecture in cytology smears makes diagnosis challenging. Traditional fine needle aspiration (FNA) smears frequently contain well-preserved live tissue fragments that are intact (tissue microbiopsies). Micro biopsies are described as live tissue fragments collected from cytology smears that are well maintained. They will contribute to the tumour ontogeny by providing information on tissue architecture. The purpose of this study was to determine the importance of microbiopsies in conventional/guided FNAC in providing a more precise diagnosis.

Aim: To investigate the role of tissue microbiopsies in conventional and guided fine needle aspiration cytology preparation, as well as the utility of microbiopsy fragments in cytological diagnosis precision.

Methods: In the Cytopathology laboratory of the Department of Pathology, Tirunelveli Medical College, Tirunelveli, a prospective study of the importance of tissue microbiopsies in fine needle aspiration cytology was studied and interpreted from June 2014 to June 2015. Swellings that were clinically palpable were evaluated in 100 cases.

Results: Out of 100 instances, 82 percent were classified as conventional FNAC, ten percent as USG guided, and eight percent as CT guided FNAC. With 34 cases (34 percent), lymph nodes had the highest yield of microbiopsies, followed by the breast (24 cases), thyroid (11 cases), lung (eight cases), salivary gland (seven cases), liver (four cases), bone and soft tissue (four cases), abdominal mass (three cases), pancreas (two cases), and ovary, spleen, and anterior mediastinum (one case each). Out of 100 cases, 56 percent were cancerous and 44 percent were benign. There were a total of 56 malignant tumours, with 41 (73.2%) being original tumours and 15 (26.8%) being metastatic tumours.

Conclusion: In situations of metastatic cancers, FNA smears including microbiopsies are more helpful in confirming the diagnosis, typing the tumour, and predicting probable primary sites than cytology alone. As a result, if employed in the evaluation of routine cytology samples, this technique can be used to improve the diagnostic accuracy of FNAC. Fine needle aspiration cytology aspirate with tissue microbiopsy, whether conventional, CT, or USG guided, is a helpful method in evaluating and identifying suspected lumps or tumours.

Author(S) Details

A. R. Jaswanthini
Department of Pathology, Tirunelveli Medical College, Tirunelveli, Tamil Nadu, India.

K. Swaminathan
Department of Pathology, Tirunelveli Medical College, Tirunelveli, Tamil Nadu, India.

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Surgical Management of Breast Lesions | Chapter 2 | Highlights on Medicine and Medical Research Vol. 11

 The most common treatment for breast lesions is surgery. To define the type of lesion and plan surgical management, diagnostic modalities and clinical evaluation are used. If patients are managed and treated according to standards and advanced approaches are used, outstanding outcomes can be achieved. Fine needle aspiration cytology, core needle biopsy/Excision biopsy, and fine needle aspiration cytology were used to diagnose patients with breast lesions who came to the surgical outpatient entrance. Modified radical mastectomy with axillary lymph node dissection and thoracoabdominal skin flaps where needed were performed in our experience. Sentinallymphnode dissection was performed, followed by axillary dissection or conservative breast surgery, as required. The accuracy of ultrasonography directed fine needle aspiration cytology in clinically node negative cases of carcinoma breast was found to be correct in more than 80% of cases. Cases that were preoperatively diagnosed as benign were surgically removed. As required, incision and drainage were carried out. Surgical management that followed the guidelines resulted in a positive outcome in our experience with breast lesions. The use of modern methods produced excellent, precise results.

Author (s) Details

Amrit Pal Singh Rana
Department of Surgery, GGS Medical College, Faridkot, India.

Manjit Kaur Rana
Department of Pathology/ Lab Medicine, All India Institute of Medical Sciences, Bathinda, India.

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