CORRELATION OF CYTOLOGICAL AND HISTOLOGICAL DIAGNOSES OF PATIENTS WITH BREAST LESIONS SEEN AT THE UNIVERSITY COLLEGE HOSPITAL, IBADAN, NIGERIA- A TEN YEAR RETROSPECTIVE STUDY (JANUARY 1996-DECEMBER 2005)

Abstract

Background: Breast lesions present commonly as a lump(s) in the breast for which
differentiation between benign and malignant lesions is often difficult using clinical
examination alone. The standard practice in the management of a breast lump since the time
of Halstead is by operative biopsy under anaesthesia and pathological evaluation of the
biopsied tissue. Fine needle aspiration cytology (FNAC) has been established as a quick,
simple and accurate alternative to open surgical biopsy.
Objectives: This study was undertaken to describe the pattern of diagnosis made on FNAC of
breast lesions at University College Hospital (UCH), Ibadan over a ten year period; to
correlate the cytological and histological diagnosis of breast lesions over the same period and
to compare the results of this study with the suggested thresholds for cytology performance
recommended by the National Health Service Breast Screening Programme (NHSBSP)
Guidelines of the United Kingdom (UK) and with similar work done previously in Ibadan and
elsewhere.
Methods: A retrospective evaluation of 1401 patients with breast lesions who had FNAC, of
which 250 had histological confirmation.
Results: Overwhelming majority (97%) of the aspirates was obtained from females with a
mean age of 39.5 years. Fibroadenoma constitutes the bulk (32.4%) of benign breast smear
category, while carcinomas constitute the bulk (97.3%) of the malignant breast smear
category. Of the 125 histologically confirmed benign lesions, 115 had been interpreted as
benign cytologically, while 3, 4, 1, and 2 cases respectively were reported as malignant,
suspicious of malignancy, atypia probably benign and unsatisfactory. There were 125
histologically confirmed malignant cases, 93 of which had been reported as malignant on
FNAC, 21 as suspicious of malignancy, 8 as benign and 3 as unsatisfactory. The positive
predictive value for malignancy was 99.3% with a complete sensitivity of 97.7% and
specificity (full) of 94.2%.
Conclusion: The high quality assurance measures, which are well above the minimum
standards recommended by the UK NHSBSP guideline for cytology, obtained in this
relatively large sample sized retrospective study confirms FNAC as a clinically effective
diagnostic procedure for breast lesions in University College Hospital, Ibadan and justifies its
use as a first line diagnostic procedure in the evaluation of patients with breast lesion in this
institution.

CORRELATION OF CYTOLOGICAL AND HISTOLOGICAL DIAGNOSES OF PATIENTS WITH BREAST LESIONS SEEN AT THE UNIVERSITY COLLEGE HOSPITAL, IBADAN, NIGERIA- A TEN YEAR RETROSPECTIVE STUDY (JANUARY 1996-DECEMBER 2005)