Suma Madathiveetil1, Jisha Kalathil Thodiyil 2, Freena Rose3
BACKGROUND
Breast cancer is now the most common cancer in cities in India and 2nd most
common cancer in the rural areas. Fine needle aspiration cytology (FNAC) is a less
invasive pre-operative diagnostic method and is preferred over core / excision
biopsy to decide the benign or malignant nature of the breast lump. Prognostic
factor assessment by FNAC would allow the identification of patients who would
benefit from neo adjuvant treatment (patients with grade 3 tumours) and in whom
conservation surgery is inadvisable.1 The purpose of this study is to compare the
grades of breast cancer in FNAC with histopathology as gold standard and compare
the oestrogen (ER) and progesterone (PR) hormonal expression pattern on
immunocytochemistry (ICC) with immunohistochemistry (IHC). From this study we
intend to assess the usefulness of cytological grading and ER, PR hormone
receptor status pre-operatively so that hormonal therapy can be included with
neoadjuvant chemotherapy.
METHODS
This is a cross sectional study with a sample size of 50, conducted in the
Department of Pathology.
RESULTS
Out of 50 cases, maximum number of patients were in the age group of 51 - 60
years. 68 % had attained menopause; 69 % of patients had tumour size between
2 - 5 cm and 90 % of tumours were in the upper outer quadrant of breast.
Considering hormonal expression, in case of ER there was a moderate agreement
between ICC and IHC (κ = .428, P = 0.005) and no agreement was seen in case
of PR (κ = .073, P = 0.625). Regarding the cytological grading, this study showed
highest degree of concordance with grade II tumours with a sensitivity of 75.9 %.
For Grade I it was 2.5 % and for grade III, it was 33.3 %.
CONCLUSIONS
Evaluation of hormonal status and nuclear grading is fairly reliable on cytology
when performed on qualitatively superior FNAC material from the primary breast
lesions.
