INTRODUCTION: Breast lump is the most common clinical presentation in most of the breast diseases. Breast cancer is the second most 1, 2 common cancer among women in India. The worldwide accepted protocol for diagnosis of breast lumps is the “Triple Assessment” a combined approach by the triad of clinical examination, mammography and pathological diagnosis by 3 Fine Needle Aspiration Cytology. FNAC is very reliable, safe, cost-effective and rapid method for diagnosis of breast lesions 1,4,5 that can be easily carried out in outpatient department. In this diagnostic era, a pathologist can perform many molecular ancillary techniques like estrogen, progesterone receptor and proliferation antigen on FNA samples and so, FNAC helps in deciding the proper therapeutic interventions 1 for the breast lumps specically in malignant lesions. As most of the breast lumps are benign in nature, the preoperative cytological diagnosis can decrease the unnecessary 6surgeries thus reducing the morbidity. FNAC has many 1benets over breast lump biopsies. FNAC has a good sensitivity, specicity and accuracy in the diagnosis of both neoplastic and non-neoplastic breast lumps thereby assist ing in early diagnosis and further 7management. The present study was conducted to study the incidence and the various cytomorphological patterns of palpable breast lesions in patients by FNAC and subsequently to compare the results with those of other studies published in literature. MATERIAL AND METHODS The present study was carried out on patients presenting with palpable breast lumps in the Cytopathology section over a period of one year from January 2019 to December 2019 in Tertiary Care Hospital. A total of 432 cases were studied with detailed clinical history, clinical examination and imaging if available and consent was taken from all the patients. FNAC was performed by using 5 ml plastic disposable syringe and disposable 23 guage needles. Three slides were made from aspirated material, two were xed with isopropyl alcohol and stained with Haematoxylene & Eosin and Papaniculou stains, while third slide was air dried and stained with May Grunwald Giemsa stain. In suspected cases of Tuberculous mastitis, special stains like ZN and Fluorescence microscopy were also studied. FNA results were obtained after correlation with clinical history and radiological ndings and then compared with ndings of other studies in the literature. RESULTS A total of 2123 cases were obtained in the department of cytology over a period of 1 year between January 2019 and December 2019 out of which 432 cases (20.4%) were FNAC of breast lumps . All the 432 patients underwent a diagnostic FNAC in Cytopathology Section. In the present study, age range of patients varied from 9 to 85 years. Youngest patient (9 year old) was diagnosed with broadenoma and oldest (85 year old) was diagnosed with lobular carcinoma on FNAC. Majority of patients (28%) were noted in the age group of 21-30 years followed by the age group 31- 40 years (24.5%) as shown in table 1. Table 1: Age wise distribution of patients CYTOMORPHOLOGICAL SPECTRUM OF BREAST LUMPS: A ONE YEAR STUDY Original Research Paper Dr. Suwarna B Patil Associate Professor, Department Of Pathology, GMC Akola, Maharastra, India Dr. Pradeep S. Umap Professor And Head, Department Of Pathology, Gmc Akola, Maharastra, India X 15GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS Pathology Palpable breast lump is the most common clinical presentation. Breast cancer is the second most common cancer among women in India. The worldwide accepted protocol for diagnosis of breast lumps is the “Triple Assessment” a combined approach by the triad of clinical examination, mammography and FNAC. FNAC has a good sensitivity, specicity and accuracy in early diagnosis and management of breast lumps. The present study was carried out on 432 patients presenting with palpable breast lumps in the Cytopathology section over a period of one year from January 2019 to December 2019 with the aim of categorizing the breast lesions among females and males, studying age incidence & laterality. Fibroadenoma (44.9%), ductal carcinoma (11.8%), acute mastitis (6.4%) were the most common benign, malignant and inammatory lesions respectively in the present study. FNAC for palpable breast lumps has proved to be an asset in the present study ABSTRACT KEYWORDS : Breast Lump, Fnac, Fibroadenoma, Ductal Carcinoma VOLUME-9, ISSUE-2, FEBRUARY-2020 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra Dr. Shweta M. Dhage* Assistant Professor, Department Of Pathology, Gmc Akola, Maharastra, India *Corresponding Author Dr. Jasleenkaur S. Oberoi Junior Resident III, Department Of Pathology, Gmc Akola, Maharastra, India Dr. Shobhana J. Agrawal Junior Resident III, Department Of Pathology, Gmc Akola, Maharastra, India Age group Number of patients Percentage 0-10 01 0.2 11-20 86 19.9 21-30 121 28.0 31-40 106 24.5 41-50 48 11.1 51-60 31 7.1 61-70 32 7.4 71-80 07 1.6 Total 432 100.0 16 X GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS Figure 1: Age and sex wise distribution of patients Out of 432 cases of breast lumps, 92.1% were found in females while 7.8% were found in males. Majority of female patients (27.5%) with breast lump were in the age group of 21-30 years while most of the male patients (2.7%) were in the age group of 61-70 years as shown in gure 1. Figure 2: Side wise distribution of breast lumps 48% cases were having right breast lump, 42% cases were with left breast lump, while 10% cases presented with bilateral breast lumps as shown in gure 2. Table 3: FNAC diagnosis of breast lesions Out of all breast lump lesions, maximum 78.9 % cases were cytomorphologically diagnosed with benign lesions while 12.2% cases were diagnosed as malignant lesions and only 8.7% cases were diagnosed as inammatory lesions. Table 4: Distribution of inammatory lesions diagnosed on FNAC Among inammatory breast lesions, on FNAC majority of cases (6.4%) were diagnosed as acute mastitis (Figure 2-C) followed by granulomatous mastitis (1.1%) (Figure 2-D), chronic mastitis (0.6%) and only two cases were Tuberculous mastitis with positivity on both ZN stain and uorescence microscopy as shown in table 4. Table 5: Distribution of benign lesions diagnosed on FNAC Among benign breast lesions, on FNAC the majority (44.9%) cases were diagnosed as broadenoma (Figure 3-A) followed by benign proliferative breast disease (15.5%), gynae co mastia (6.9%), brocystic disease (5.5%), galactocele (3.2%), benign phyllodes tumor (2.5%) (Figure 3-E)and one female patient was having both broadenoma and phyllodes tumor with bilateral breast presentation (Table 5). Table 6: Distribution of malignant lesions diagnosed on FNAC Among malignant breast lesions, on FNAC 11.8% cases were diagnosed with ductal carcinoma (Figure 3-B) out of which 2 patients were males. While we got only one case of each lobular carcinoma and malignant phyllodes tumor each, diagnosed on FNAC. Table 7: Distribution of bilateral breast lesions Among bilateral breast lesions, broadenoma (38%) was the most common lesion followed by proliferatibe breast disease (28.5%) and brocystic breast disease (11.9%) as shown in table 7. Figure 3: Cytomorphological spectrum of breast lesions (A, B, C, D, E) E) Benign phyllodes tumor (HE, 100X) VOLUME-9, ISSUE-2, FEBRUARY-2020 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra Breast lesions Number of cases % Inammatory 38 8.7 Benign 341 78.9 Malignant 53 12.2 Total 432 100 Inammatory lesions Number of cases % Acute mastitis 28 6.4 Chronic mastitis 03 0.6 Granulomatous mastitis 05 1.1 Tuberculous mastitis 02 0.4 Benign lesions Number of cases % Fibroadenoma 194 44.9 Benign phyllodes tumor 11 2.5 Fibroadenoma and phyllodes tumor 01 0.2 Fibrocystic disease 24 5.5 Gynaecomastia 30 6.9 Galactocele 14 3.2 Proliferative breast disease 67 15.5 Malignant lesions Number of cases % Ductal carcinoma 51 11.8 Lobular carcinoma 01 0.2 Malignant phyllodes tumor 01 0.2 Breast lesions Number of patients % Fibroadenoma 16 38.0 Proliferative breast disease 12 28.5 Benign Phyllodes tumor 01 2.3 Galactocele 02 4.7 Fibroadenoma with Phyllodes tumor 01 2.3 Fibrocystic breast disease 05 11.9 A) Fibroadenoma (HE, 100X) B) Ductal carcinoma (HE,400X) C) Acute mastitis (HE, 200X) D) Granulomatous mastitis (HE, 100X) Majority of inammatory breast lesions (20/38) were noted in the age group of 21-30 years. Among benign lesions, maximum cases of broadenoma (65/194) were noted in 21-30 years age group while majority of proliferative breast disease (22/67) were noted in 31-40 year age group. Maximum cases of gynaecomastia in males were noted in older age group of 61- 70 years. Most of the cases of brocystic disease were seen in middle age group of 41-50 years while cases of galactocele were commonly seen in younger age group of 21-30 years. Patients of benign phyllodes tumor were mainly seen in 31-40 years while one case of malignant phyllodes tumor was 33 year old only. Majority of ductal carcinoma cases were found in the older age group of 51-60 years while lobular carcinoma was diagnosed in 85 year old female (Table 8). A total of 34/432 cases were male patients out of which 30 cases were of gynaecomastia, 2 cases were diagnosed as ductal carcinoma (one with metastasis to axillary lymph node), 1 case each of acute mastitis and proliferatibe breast disease. DISCUSSION There has been increasing use of FNAC of breast lump as preoperative diagnostic tool because of awareness among the clinicians of its role. It is well tolerated and readily accepted by patients as they get report within a short span. We studied a total of 432 cases of breast lump and above results were obtained. These results were compared with various studies in the literature. In the present study, maximum patients (28%) were observed in 21-30 year age group followed by 31-40 years (24.5%) while 3 1 in the studies done by Ahmad F et al (30.7%), Badge S A et al (45%) the most common age group was 31-40 years. This disparity in the observation may be explained on the basis of decreasing age incidence of breast lumps over the last few decades and also on the basis of increasing awareness among females of all age groups for breast lumps. In the present study, right breast (47.9%) involvement showed slight 3predominance over left breast (42.3%) while Ahmad F et al noted left breast involvement predominant. The percentage of benign lesions in the present study was 78.9%. This was similar to the ndings made by Bukhari et al, Rocha et al, 1,8-11Feichter et al, and Singh et al . While the malignant lesions in the present study were 12.2% which was similar to ndings 12of Pradhan et al but slightly less as compared to the studies 1 8 9done by Badge S et al , Bukhari et al , Rocha et al . In the present study, inammatory lesions were the least common 6similar to the ndings of Dr Jayanandhini M et al . In the present study, broadenoma was the most common benign lesion which was similarly noted by the study conducted by 1 6 13Badge S et al , Dr Jayanandhini M et al , Bell et al . Whereas among malignant lesions, ductal carcinoma was the most common in present study similar to ndingd by Badge S A et al 1 14 and Mohammad et al .In this study, among inammatory lesions acute mastitis was the most common lesion which also 6observed by Dr Jayanandhini M et al . This observation may probably be due to poor hygiene in the low socioeconomic strata during lactation phase in this geographical area. Overall, in the present study, the most common benign lesion (broadenoma) was seen in younger age group of 21-30 years 1while Badge S A et al noted it in age group of 31-40 years and malignant lesions in our study were common age group of 51- 160 years while Badge S A et al observed most malignant lesions in 41-50 years. CONCLUSION FNAC is a safe, simple, reliable and cost-effective, well tolerated preoperative procedure done in outpatient department yielding accurate diagnosis of inammatory, benign and malignant breast lesions. Most of the breast lumps are benign and broadenoma is the commonest while among malignant lesions, ductal carcinoma is the prevalent breast lesion. Among inammatory category, acute mastitis is the common presentation. Benign lesions are predominantly seen in younger age group while malignant lesions are seen in older age group with few exceptions of young patients. Suspected cases of Tuberculous mastitis can also be positively diagnosed on FNAC. So, this simple and time saving procedure is a boon for both clinicians and anxious patients as malignancy in suspicious cases gets ruled out within no time. As overall incidence of malignancy is rapidly increasing all over the world and hence in developing countries like India, a safe & rapid diagnostic tool like FNAC for palpable breast lumps has proved to be an asset. 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