Comparison of Mammography, Sonography, Fine-Needle Aspiration Cytology, and Excision Biopsy for the Diagnosis of Breast Lesions

Background and Objective: Problem of invasive tests in breast lesion diagnosis can be addressed by comparing noninvasive tests with final Histopathological diagnosis obtained a?er excision biopsy. Present study was carried out to study diagnos?c u?lity of mammography, sonography, FNAC compared to excision biopsy for diagnosis of breast lesions Methods: Prospec?ve Observa?onal study was carried out among 81 women with Breast related symptoms. Digital Mammography Machine, ACUSON S3000TM Ultrasound System; FNAC and surgery for excision Biopsy were used. Sensi?vity, Specificity, Accuracy, Posi?ve and Nega?ve Predic?ve values were measured and p<0.05 was considered as sta?s?cally significant. Results: Sonography and FNAC composite have sensi?vity, specificity, accuracy, posi?ve and nega?ve predic?ve values 100.00%, 81.40%, 90.12%, 82.61% and 100.00% respec?vely. Mammography+FNAC (97.3%) is not as sensi?ve as Sonography+FNAC (100%), Sonography combined with FNAC is equally sensi?ve to excision biopsy (100%) and therefore can be used for screening purpose. Conclusion: Contrary to present guidelines which consider Mammography as most important screening tool for Breast Cancer, combina?on of Sonography and FNAC can be considered equally reliable.

Enfermedad de Paget de la mama en una paciente suazí / Paget´s disease of the breast in a suazi patient

Se describe el caso clínico de una paciente de 63 años de edad, quien acudió a la consulta de Oncología del Hospital Gubernamental de Mbabane, en Suazilandia, por presentar una lesión ulcerada en el pezón de la mama izquierda desde hacía 1 año. Luego de realizarle una biopsia por escisión, que reveló la presencia de la enfermedad de Paget, clasificada en el estadio 0 según los resultados de los exámenes complementarios, se decidió remitirla al Servicio de Cirugía donde le practicaron una mastectomía simple. La paciente mostró buena evolución clínica y se mantenía estable hasta la última consulta en que fuera asistida

The case report of a 63 years patient who went to the Oncology Service of the Government Hospital of Mbabane, in Swaziland is described, due to an ulcerated lesion in the nipple of the left breast for 1 year. After carrying out an excision biopsy that revealed the presence of the Paget´s disease, classified in the stage 0 according to the results of the complementary tests, she was referred to the Surgery Service where a simple mastectomy was carried out. The patient showed good clinical course and she remained stable until the last appointment when she was assisted

Cervical Lymphadenopathy—Pitfalls of Blind Antitubercular Treatment.

Tuberculosis (TB) is the most common cause of cervical lymphadenopathy in the TB-endemic zone, like India but it can also mimic other diseases. Four cases of cervical lymphadenopathy presented to us as initial treatment failure after completion of six months of antitubercular drugs (ATD), including rifampicin, isoniazid, pyrazinamide, and ethambutol. All were diagnosed as having tuberculosis either by fine needle aspiration cytology or clinically from outside our institution. In one case, tuberculosis was the final diagnosis but, unfortunately, it was multidrug-resistant. In other three cases, Hodgkin disease, Non-Hodgkin lymphoma, and Kikuchi’s disease were the diagnoses. In resource-poor countries, like India, which is also a TB-endemic zone, TB should be the first diagnosis in all cases of chronic cervical lymphadenopathy, based on clinical and/or cytological evidences. So, they were correctly advised antitubercular therapy (ATT) initially. Sometimes, TB mimics other aetiologies where apparent initial improvement with ATT finally results in treatment failure. Hence, investigations for microbiological and histopathological diagnosis are warranted, depending on the resources and feasibility. If these tests are not routinely available, the patients should be under close monitoring so that lymphoma, drug-resistant TB, or other aetiologies of cervical lymphadenopathy are not missed. Patients with cervical lymphadenopathy rarely presents acutely; so, a physician can take the opportunity of histopathological study of lymphnode tissue.

Selection of mode of biopsy in histopathological diagnosis of Soft tissue sarcoma depending on diagnostic accuracy and feasibility: Debatable issue in modern era.

Background: Biopsy method of choice is a controversy issue for diagnosis of soft tissue sarcoma which are traditionally been managed by wide excision surgery and radiotherapy. Chemotherapy is reserved for advanced cases. Aims & Objective: The objective of study was to evaluate diagnostic accuracy of various modes of biopsy focusing on image guided core needle biopsy (CNB). Material and Methods: Current study includes 50 cases of soft tissue sarcoma from January 2010 to October 2012. The Mode of biopsies included image guided CNB, open and excision biopsy. Effective accuracy of each was determined by accuracy of biopsy to provide adequate tissue for histopathological and other special examinations like immunohistochemistry to reach final diagnosis. Results: Out of total 50 cases CNB was done in 13 cases, open biopsy in 2 cases and in 35 cases excision biopsy was done. CNB was adequate in 92.31 % cases and 7.69 % cases it was inadequate. Open and excision biopsy were 100 % adequate. Conclusion: Image guided CNB is very helpful in early diagnosis and shows high accuracy especially for high-grade sarcoma. It is less invasive compared to others and differentiate benign from malignant. It is handful when preoperative diagnosis is essential for planning pre-operative chemotherapy especially in patients with primarily inoperable, advanced tumour with compromised performance status or recurrent tumour. But it should be properly directed and representative of whole tumour and require full radiological correlation by experienced hands. Tumours with myxoid pattern, lipomatous tumours and low grade sarcomas encounters lower diagnostic accuracy on CNB.

Different Types of Breast Lump in Relation to Different Age Groups.

This prospective observational study was carried out in the inpatient and outpatient department of surgery at Shaheed Ziaur Rahman Medical College Hospital, Bogra, during the period of 01.07.2008 to 31.12.2008 with a view to find out the incidence of breast carcinoma, fibroadenoma or other pathology in different age group. A total 130 patients with palpable breast lump were included in the study. Age of the patients was between 11 to 70 years. In most of the patients with breast lump Fine Needle Aspiration Cytology and biopsy were done. Sometimes ultrasonography, mammography and other routine investigations were also done. Among the study population 53.85% had benign lesions, Breast carcinoma accounted for 46.15% cases, fibroadenoma for 40.76% and fibroadenosis were in 10% cases. Fibroadenoma was common in second and third decade, while carcinoma of breast was common in third and fourth decade in this study. Here we attempted to find out the age incidence of breast lump and its correlation with clinical features, FNAC findings and histopathological report to improve the accuracy of diagnosis and management of breast disease.

Fine needle aspiration cytology in childhood TB lymphadenitis.

Objective. To evaluate the efficacy of Fine Needle Aspiration Cytology (FNAC) to diagnose Tuberculous (TB) lymphadenitis with compare to excision biopsy and to correlate TB lymphadenitis with clinical, cytological, radiological and mantoux test features. Methods. This was a prospective correlational study. FNAC was done by a pediatrician for 135 children with persisting lymphadenitis after two weeks of antibiotic therapy in the period of January 2005 to June 2006 and compared with excision biopsy in a tertiary care hospital. Results. Forty Six cases (34.07%) were TB lymphadenitis diagnosed by FNAC. Excision biopsy and cytological correlation was done in 100 cases. Sensitivity, specificity and diagnostic accuracy for TB lymphadenitis were found to be 98%, 100% and 99% respectively. Positive and negative predictive values were 100 and 98 respectively. Large (>2cm) (86.9%), multiple (52.1%), matted (47.8%), posterior cervical and submandibular group nodes with history of contact (P=0.0016), positive mantoux test (P=0.0001) and Grade III and IV Protein Energy Malnutrition (PEM) (P=0.0041) were significantly seen in TB lymphadenitis. Ziehl Neelson staining for Acid Fast Bacilli (AFB) was positive in 32.5% cases of TB Lymphadenitis. Conclusion. Pediatrician himself can do FNAC which is an excellent first line method to diagnose TB lymphadenitis and it has equal accuracy to excision biopsy.

It is necessary to excise all breast lesions? Experience from a university - based breast unit

Background: Breast cancer is becoming more important in Asia since it affect the younger age group. Question arises whether it is safe for breast lesions to be left in-situ if all the elements in triple assessment are benign. The aim of this study is to audit all the excision biopsies of breast lumps done in the University Malaya Medical Centre (UMMC), to review the association of age with the type of pathological finding and to evaluate the rate of carcinoma in these biopsies. Methods: We conducted a retrospective study of all women who had excision biopsy of a breast lump in the University Malaya Medical Centre from January 2005 to December 2006. All patients with malignant preoperative biopsies were excluded. Results: Of 717 lesions in 664 patients, 459 (64%) were fibroadenoma, 114 (15.9%) were fibrocystic disease, 20 (2.8%) were phylloides tumour, 27 (3.8%) were papilloma, 59 (8.2%) were malignant and 38 (5.3%) were of other pathology. Of the 717 open biopsies, 449 (62.6%) had fine-needle aspiration cytology (FNAC), 31 (4.3%) had core needle biopsy (CNB), while 14 (2.0%) had both FNAC and CNB done prior to excision biopsy. 251 (35%) had neither FNAC nor CNB. The incidence of fibroadenoma decreased with increasing age and the incidence of fibrocystic changes and papilloma increased with increasing age. There was no association of age with phylloides tumour. The incidence of unexpected malignancy increased with increasing age. The incidence rates were 0.3%, 4.5%, 19.4%, 29.7% and 29.6% for the age group below 30, 30-39, 40-49, 50-59 and above 60 years of age respectively. Of the 59 malignant lesions, FNAC was performed on 47 (79.7%) and CNB on 16 (27.1%). 9 had both FNAC and CNB and 3 had neither FNAC nor CNB. Out of the 56 lesions where FNAC/CNB were done, 23 (41.1%) were reported as benign, 20 (35.7%) as suspicious, 4 (7.1%) as atypical, 5 (8.9%) as inadequate, 2 (3.6%) as equivocal and 2 (3.6%) as lymphoid lesions. Out of the 23 prior biopsies reported as benign, 22 were in the age group above 40. Conclusions: In conclusion, the rate of unexpected malignancy in open biopsies increases with age. It is recommended that all women above the age of 40 presenting with a palpable breast lump or a suspicious non-palpable abnormality on screening mammogram to have their lump excised even though the lump is benign on FNAC or CNB. However, women age of 30 to 39 should also have the lump excised in the presence of other risk factors such as family history of breast cancer.