Cytological evaluation of breast lesions in symptomatic patients presenting to Kenyatta National Hospital, Kenya: a retrospective study

Abstract

BackgroundPalpable breast lump, breast pain, and nipple discharge are common symptoms of breast disease. Breast cytology (fine-needle aspiration, nipple discharge smear, and touch preparation) accurately identifies benign, atypical, and malignant pathological changes in breast specimens. This study aims to determine the types of breast lesions diagnosed by breast cytology and assess the clinical adequacy of narrative reporting of breast cytology results.MethodsMedical records of 390 patients presenting to breast or general surgery clinics in Kenyatta National Hospital, Nairobi, Kenya, between January 2010 and March 2014 were evaluated retrospectively.ResultsOf the 390 diagnosed breast lesions, 89.7 % (n = 350) occurred in females, while 10.3 % (n = 40) occurred in males, giving rise to a female-to-male ratio of 8.8:1. Neoplastic breast lesions (n = 296) comprised 75.9 %, while non-neoplastic breast lesions (n = 94) comprised 24.1 % of all diagnosed breast lesions. The neoplastic lesions were classified as 72.3 % (n = 214) benign and 27.7 % (n = 82) malignant, resulting in a benign-to-malignant ratio of 2.6:1. Fibroadenoma (n = 136) and gynecomastia (n = 33) were the most frequently diagnosed breast lesions for women and men, respectively.ConclusionsBreast cytology effectively diagnosed neoplastic and non-neoplastic breast lesions. Neoplastic breast lesions occurred more frequently in women whereas non-neoplastic lesions occurred more frequently in men. To address the limitations associated with narrative reporting of breast cytology results, a synoptic reporting format incorporating the United Kingdom’s National Health Service Breast Screening Programme’s diagnostic categories (C1 to C5) is recommended for adoption by this hospital.

International Academy of Cytology Yokohama System for Reporting Breast Fine-Needle Aspiration Biopsy Cytopathology: A Review of Predictive Values and Risks of Malignancy

“…Breast FNAB cytology and CNB each has complimentary roles, even though the selection of which test to use is sometimes reduced to FNAB or CNB [8, 9]. It is important to recognize that the use of breast FNAB has been of growing significance in resource-limited settings where imaging is not readily available, and this quick, inexpensive, minimally invasive, and reliable technique is used for the diagnosis of breast lesions [10-12]. The purpose of the IAC Yokohama System for Breast FNAB Cytology is to standardize the reporting of breast FNAB cytology and provide improved diagnostic consistency throughout these different practice settings.…”

“…Breast cancer metastases to regional lymph nodes or distant sites are related topics and are not discussed here. Breast FNAB plays an increasing role for breast cancer diagnostics globally, and standardized reporting is of high importance to increase diagnostic confidence and compare of outcomes between diverse clinical settings [5, 10-12, 30-33]. …”

Distribution of breast lesions diagnosed by cytology examination in symptomatic patients at Eritrean National Health Laboratory, Asmara, Eritrea: a retrospective study

“…Malignant breast disorders are grave diseases and remain to be the leading cause of mortality and morbidity among women population [ 3 , 4 ]. There is a high prevalence of neoplastic and non-neoplastic breast lesions in females of Sub-Saharan Africa region [ 5 ]. In Eritrea, a ten-year retrospective study done by Faisal M. et al at Eritrean National Health Laboratory (ENHL) documented that the most common tumor diagnosed in female patients was breast cancer with age standardized incidence rate of 2.7 cases in every 100,000 living females [ 6 ].…”

“…The physical, psychological and financial costs of investigating benign breast disease with an intent to exclude malignancy are significant [ 7 ]. Common clinical symptoms of human mammary gland lesions include palpable breast lump, breast pain, and nipple discharge [ 5 ]. During evaluation of a breast lump, a physician is challenged as to whether the mass could be pathologic or normal variant of a breast tissue.…”

Cytomorphological Patterns of Palpable Breast Lesions Diagnosed on Fine Needle Aspiration Cytology in Jimma Hospital, Ethiopia

“…FNAC is one component of triple assessment (the other two are clinical examination and mammography) of palpable breast lumps. It is an accurate, rapid, simple, cost effective and reproducible diagnostic tool (8,10,14,16).…”