Background: The expected and significant role of cytological diagnosis is to distinguish benign from malignant processes. Fine needle aspiration cytology (FNAC) of the breast has two main goals. One is to confirm a radiological and clinical benign lesion and avoid unnecessary surgery and the other is to confirm a malignant diagnosis and allow definite treatment planning. Methods: In breast lesions, rapid diagnosis by aspiration cytology can be particularly useful for allaying the apprehension and anxiety of the patient whose apparent solid mass may turn to be a cyst, thus reducing the anguish and morbidity associated with unnecessary surgical procedures. If the lesions turn out to be malignant, the patient can be referred for immediate treatment on priority so that treatment is not unnecessarily delayed. Thus, aspiration cytology is used more and more in the diagnosis of benign and malignant lesions of the breast. It is a cost-effective and safe method that can differentiate benign and malignant lesions accurately. In advanced carcinoma or unwilling patients for surgery, it can form the basis of management. The objective of this study was to analyze cases of FNAC of breast lesions. Results: This study was a cross-sectional study including all the patients with breast lump who attended Dhaka Community Medical college Hospital for FNAC. A total 50 cases of all ages and both sexes were included in this study. Smears made from aspirated material were collected and examined. Most of the aspirates were from females. There were more benign lesions (43 cases) as compared to malignant cases (seven cases). Fibroadenomas were the most benign lesion of breast. The age of malignant cases ranged from 21 to 60 years with a majority of cases in the age group of 41-50 years (four cases, 57.1%). Conclusion: FNAC is less time-consuming, safe, useful and highly accurate technique for breast masses and can segregate benign and malignant lesions with accuracy. Triple assessment by clinical, radiological and pathological examination is a standard approach in the evaluation of breast lumps. The clinical and radiological presentations of both benign and malignant lesions can be similar-as a hypoechoic focal mass, occasionally inflammatory lesions may mimic mass-like lesions or appears as non-homogenous regions on radiographs. Here, FNAC can play a major decisive diagnostic role and minimizing the requirement of biopsy.
HER-2 (also known as HER-2/neu) is a member of the epidermal growth factor (EGF) receptor family. The amplification of oncogene HER-2 is presented in 20 to 30% of breast cancers and results in an increase of the protein expression. HER-2 over expression has also been shown to correlate with poor prognosis. It is associated with poorly differentiated high grade tumors with lymph node involvement, greater risk of recurrence and relative resistance to some types of chemotherapy. The receptor is however a target for treatment with anti HER-2 antibody trastuzumab (Herceptin). Immunohistochemistry analysis for HER 2 scoring is subjective, requires trained personnel and expertise. One of the main concerns with IHC is that there is evidence of significant inter-observer variation in the assessment of staining, which can lead to misclassification of HER2 status. Chromogenic in situ hybridisation (CISH) testing is sensitive and specific in detecting HER-2/neu gene amplification. Direct evaluation of gene amplification using CISH assay is a reliable method for routine diagnostic evaluation of HER2/neu status in breast cancer patients, especially in specimens showing 2+ IHC score. This observational experimental study was carried out in the Department of Pathology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, during the period of July 2014 to June 2015, The aim of this study was to assess HER-2 expression accurately in equivocal immunohistochemistry (2+) invasive breast cancer cases by Chromogenic in situ hybridisation and to associate the findings of CISH assay with the histologic prognostic and predictive factors (eg: tumor size, regional lymph node metastases, tumor grade and type. A total of 20 archival paraffin tissue blocks and IHC slides with IHC score 2+ for HER-2 were included in this study. All the slides were reviewed. CISH assay was done on section from archival paraffin block.CISH assay showed amplification of the HER-2 neu gene in 30% of cases. Majority (60%) was nonamplified. In two cases the results were unsatisfactory for interpretation. The differences were not statistically significant (p>0.05) among three groups (amplified, nonamplified and unsatisfactory) regarding the baseline characteristics (age and sex) with CISH. All the results of CISH assay in association with tumor size, tumor grade and lymphnode metastasis were not statistically significant. HER-2 / neu status is the one of the most important prognostic and predictive factor. It is a target for treatment with anti HER-2 antibody trastuzumab (Herceptin). Detection of HER-2/ neu status by IHC may sometimes be difficult and inaccurate, specially in IHC score 2+ cases. Based on the findings of the study, CISH can be considered as a useful, simple and reproducible method for detecting HER-2/ neu gene amplification in cases with borderline (2+) immunohistochemistry score and patients may be benefited from Trastuzumab therapy.
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