BIRADS, Cytopathology and Histopathological Approach for Diagnosis of Breast masses in Erbil, A comparative Study

Abstract

Background: Breast masses are the most common surgical problems among females;  that  is  why  their  management  requires  an  efficient  and  accurate evaluation using the least invasive and most accurate methods with a minimal patient’s discomfort.
Objectives:  To  determine  the  reliability  and  application  of  sonographic BIRADS lexicon in comparison with Fine needle aspiration cytology and Core needle biopsy results in order to differentiate benign from malignant breast masses. Also to determine the accuracy of FNAC and CNB in diagnosis of breast  masses,  including  the  sensitivity,  specificity,  positive  and  negative predictive values of both techniques in Erbil city and to compare the results of this study with those of others. 
Materials and Methods: This is a crosssectional study that was conducted on 132 female patients with breast masses who attended the breast cancer unit in Erbil at Rizgari Teaching Hospital, Maternity Teaching Hospital and some private clinics in a period spanning from 15 th July 2012 to 15 th February 2013. After  being  detected  sonographically,  sonographic  guided  fine  needle aspiration cytology (FNAC) and core needle biopsy (CNB) of breast masses were performed. Masses were classified according to the sonographic BIRADS lexicon,  FNAC  and  CNB.  Pathological  results  were  compared  with sonographic features. 
Results:  
Hypoechoic  breast  mass  with  axillary  lymph  nodes  had  shown  highest presentation on BIRADS classification (30 samples of FNAC) in which most of them (70%) were malignant C5, while on CNB irregular hypoechoic mass had the highest presentation 29 samples were (79.3%) malignant B5. BIRADS, FNAC comparison had a high sensitivity of (97.5%) and negative predictive value of (92.8%). However, this study revealed a lower FNAC specificity (62.2%)  and  positive  predictive  value  (73.6%).  In  the  same  line,  CNB sensitivity  and  negative  predictive  value  were  high  95.5%  and  92.6% respectively  while  the  specificity  and  positive  predictive  value  were  low (59.5% and 71.7%). 
Conclusions: The BIRADS classification revealed that the highest frequencies of breast masses were among U5 (highly suspicious of malignancy) and U4 (suspicious of malignancy). Ultrasonic morphologic grading revealed that less than 30% of irregular outline masses of breast masses with axillary lymph nodes were benign masses and the reverse is true for those with well-defined masses or parenchymal changes.