The accuracy of abnormal cytology report in breast fine needle aspiration alone and in combination with clinical and imaging findings - a hospital based five year study in Kuwait

Abstract

Background: Abnormal cytology report (C3 - C5) is routinely used as part of the triple assessment in diagnosis of malignant breast lesions. Its value has been questioned in recent years in view of an equivocal (C3, C4) results when compared with core biopsy. The aim of this study was to find the significance of abnormal report of cytology alone and in combination with clinical and image findings; and how accurately it helps in clinical decision making.

Material and methods: We analysed 255 consecutive cases of abnormal cytology which had follow-up histopathology in our hospital from June 2002 to May 2007. The positive predictive value (PPV) was calculated alone and in combination with clinical and image findings. The PPV was also done in subsets according to patient age (< and >or= 50 years). In addition, sensitivity, specificity, predictive values, and likelihood ratios (LRs) were determined for each broad category of triple test.

Results: The PPV of C3, C4, C5 report alone was Introduction The combination of clinical examination, imaging ultrasound (US) and/or mammogram and fine needle aspiration cytology (FNAC) is 20%, 87.2%, and 100% respectively. C5 report is unequivocal proof of malignancy irrespective of age, clinical, and radiologic findings. Higher levels of PPV can be attained when C4 cytology is combined with suspicious clinical and radiological findings (93.8%). Patients with >or= 50 years age with C4 cytology proved mostly malignant on histology (18/19) suggesting that an intra-operative frozen section may be more relevant in older age patients with C4 report since an additional core biopsy in these patients may still be inconclusive. C3 is the least useful and even when combined with suspicious clinical and radiological findings its PPV reached 54.6%, thus prompting a preoperative biopsy.

Conclusion: Our study indicates that FNAC is still a valid and useful test in diagnosis of breast lesions and is critical to the surgeons in decision making. Moreover it gives outstanding results when combined with clinical and radiological findings in diagnosis and management of breast cancer.