~ 32 ~ International Journal of Clinical and Diagnostic Pathology 2020; 3(3): 32-38 ISSN (P): 2617-7226 ISSN (E): 2617-7234 www.patholjournal.com 2020; 3(3): 32-38 Received: 22-05-2020 Accepted: 24-06-2020 Dr. Garima Vijayvergiya Senior Resident Pathology and Lab Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India Dr. Leena P Naik Professor and HOD Lokmanya Tilak Municipal Medical College and Sion Hospital, Mumbai, Maharashtra, India Dr. Kanchan S Kothari Associate Professor, Seth GS Medical College and KEM Hospital Mumbai, Maharashtra, India Corresponding Author: Dr. Garima Vijayvergiya Senior Resident Pathology and Lab Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India Utility of fine needle aspiration cytology (FNAC) in diagnosis of papillary lesions of the breast Dr. Garima Vijayvergiya, Dr. Leena P Naik and Dr. Kanchan S Kothari DOI: https://doi.org/10.33545/pathol.2020.v3.i3a.257 Abstract Background: Diagnosis of lesions of the breast using Cytological screening is difficult. Understanding the common cytological features of papillary lesions of the breast can be useful for the diagnosis. Aims and objectives: To determine the utility of Fine Needle Aspiration Cytology (FNAC) in the diagnosis of papillary lesions of the breast Materials and methods: A retrospective study was performed from January 2010 to December 2015 in the cytology section, Department of Pathology of a tertiary care and referral hospital including patients diagnosed as papillary lesion on FNAC. Eight four cases were found (includes 44 cases which had histopathology follow-up, 36 cases which didn’t had follow-up), 4 cases were removed because of non-availability of slides. Thus, a total of 44 breast aspirates and their corresponding histology were reviewed. All the observations were done on total 44 cases. Results: Papillary Neoplasms on FNAC (n= 33): 13 cases (29.54%) were histologically confirmed as papillary neoplasms. All 13 cases (100%) showed true papillae with fibrovascular cores. 76% showed presence of columnar cells. 4 were benign and 9 malignant. Dyscohesion and severe atypia was only seen in malignant neoplasms. 20 cases were non papillary lesion on histopathology. Out of the 20 cases, 11 cases (55%) were infiltrating duct carcinoma (IDC), 4 were fibroadenomas (FA), 3 fibrocystic disease and one each was ductal carcinoma in situ (DCIS) and lobular carcinoma. Presence of papillaroid fragments and columnar cells was the most common cause for false positive diagnosis. Papillary Neoplasms Not Suspected Cytologically (n=11): In 5 cases cellularity was scanty and unsatisfactory for opinion. Missing fibrovascular cores in the aspirate was the cause of false negative diagnosis. The overall incidence of false positive was 25% and false negative was 13.75%. Sensitivity of FNAC to diagnose papillary lesions was 54.1%. Conclusion: Cytodiagnosis of papillary lesions is challenging and identification of true fibrovascular cores is essential for accurate diagnosis. Keywords: Papillary lesions, fine needle aspiration cytology, histopathology, neoplasms Introduction Papillary lesions of the breast encompass a wide spectrum of benign and malignant entities constituting <2% of all breast carcinomas [1] . Papillary lesions of the breast include benign (papilloma) as well as malignant (papillary carcinoma) entities. Both the ends of the spectrum are characterized by the presence of fibrovascular cores (FVC) lined by epithelial proliferation with varying degrees of atypia [2] . Though a definite diagnosis of the nature of tumour is possible on an excision biopsy, the distinction is not easy on aspiration cytology. This is due to the overlapping of cytological features between benign and malignant as well as other entities containing papillary component [3] . Cytological interpretation of papillary lesions of breast continues to be a difficult task. These lesions top the list of conditions in which there is a risk of false-positive diagnosis. Three- dimensional papillary clusters in a breast aspirate may be seen in a broad spectrum of conditions, namely papillary hyperplasia in fibrocystic disease, duct papilloma, papillary or micropapillary ductal carcinoma and pseudopapillary pattern in invasive ductal carcinoma (not otherwise specified) [4] . Hence, in present study we tried to determine the utility of Fine Needle Aspiration Cytology (FNAC) in diagnosis. Materials and Methods The present study was undertaken retrospectively from January 2010 to December 2015 in the cytology section, Department of Pathology of a tertiary care and referral hospital.