COMPARISON OF DIFFERENT CYTOLOGY TECHNIQUES (FNAC, MLBC, CELL BLOCK) IN DIAGNOSIS OF BREAST LESIONS Dr Nandini N.M Prof, Dept of Pathology JSSMC,a constituent of JSS University,Mysore

Introduction Objectives of the study Material and methods Observations Figures Other investigations Discussion Conclusion

Introduction Breast Cancer is the most commonly diagnosed cancer among women. Incidence raising in traditionally low-incidence Asian countries. Due to their changing lifestyles, increase in economic status and changing food habits made up of rich diet.

Introduction Fine-needle aspiration (FNA) is a safe and cost-effective technique for the diagnosis of breast lesions. Manual liquid-based cytology (MLBC) improves on FNA by avoiding limiting factors such as obscuring material, air-drying and smearing artifacts . Cell block technique helps to provide material for immunocytochemistry which plays an important role in clinical management of breast lesions. Our study tries to compare all these methods of diagnosing breast lesions, highlighting on their advantages and working on their limitations.

Objectives of the study To compare different cytological methods : FNAC,MLBC and Cell block (CB) in diagnosis of breast lesions. To study the utility of each method in diagnosis of breast lesions. To understand the advantages and limitations of each method. Use of immunocytochemistry (ICC) on MLBC and CB. To correlate cytological diagnosis with histopathological diagnosis wherever possible.

Material and Methods Our study was conducted in the Cytology section, Department of Pathology, JSS Medical College and includes 60 cases of Breast lesions. Patients ranged from 15 to 70 years of age. It compares FNAC, Manual liquid based cytology (MLBC) and cell block (CB) methods with HPE correlation wherever possible. Immunocytochemistry (ICC) was used to study the uses of these methods and their limitations.

Material and Methods… A minimum of 3 passes, one for each method was done. The material obtained were processed separately. 4-6 FNAC slides were made, stains used were H&E, PAP and MGG. Material for MLBC was put into MLBC solution and processed to make three slides (H&E, PAP, ICC). Material for cell block was put into cell block fixative, allowed to fix overnight, deposit obtained was processed as histopathological tissue.

Distribution of neoplastic and non- neoplastic breast lesions Clinical Age Range

Cytological diagnostic categories with histopathological correlation SI . NO DIAGNOSTIC GROUP FNAC MLBC CELL-BLOCK HPE 1 Fibroadenoma 22 21 16 20 2 PBD without Atypia 10 8 4 3 PBD with atypia Cystosarcoma Phylloides 5 Lactating adenoma 6 Benign breast disease 7 Malignancy 9 Non- neoplastic lesions Unsatisfactory - TOTAL 60 54 43 38 Cytological diagnostic categories with histopathological correlation

FNAC : CA Breast (H&E, 10X) MLBC: CA Breast(PAP, 20X) MLBC: CA Breast ER Positive, (40X)

CB: CA Breast (H&E, 20X) CB: CA Breast, ER POSITIVE (40X) CB: CA Breast, PR Negative (10X) CB: CA Breast, HER2 Postive [(Score1)40X]

HPE: CA Breast, ER Control (20X) HPE : CA Breast (H&E, 40X) HPE: CA Breast(score 6), ER Positive,(20X) HPE: CA Breast, PR negative,(20X) HPE: CA breast,HER2(Score1) Positive, (20X)

MLBC: FA (PAP,20X) FNAC: FA (H&E, 20X) CB: FA (H&E,40X) HPE: FA (H&E,20X)

MLBC : Lactating Adenoma ( H&E, 40X) FNAC : Lactating Adenoma (H&E, 40X) CB : Lactating Adenoma (H&E, 20X) HPE : Lactating Adenoma (H&E, 20X)

Other investigations All haematological investigations were done for cases with histopathological confirmation. Benign breast disease cases were done under sonographic guidance.

Discussion Out of the 60 cases, 38 cases correlated Histopathologically (64%), 27 cases were benign (96%), 1 case of benign breast disease turned out to be intraductal papilloma. 8/11 cases of Malignancy correlated with HPE (73%), 2 cases went to higher center for treatment, one case was unfit for surgery. 2/5 Non- Neoplastic cases correlated histopathologically (43%), 3 cases of abscess were given non –surgical treatment .

Discussion… Clinico-cytological correlation was 55/60 cases (92%). 4 cases diagnosed clinically as malignant were cytologically benign. 1 case which was diagnosed as clinically benign was diagnosed cytologically malignant.

Advantages FNAC breast is a cost effective, quick and painless diagnostic method for breast lesions. MLBC helps in getting a clear background. It also helps to study the nuclear features. It also highlights ICC finding clearly. Cell block is a good ancillary technique especially in Ca breast cases. Multiple sections can be taken to study a panel of markers. The composition of RBC lysing agent (2 drops of 1% glacial acetic acid in 95% alcohol fixative) to remove background RBCs is very important. It is very useful in haemorhagic samples

Limitations All the 3 techniques require proper sampling where adequate individual passes are required for each technique. MLBC is best in cellular lesions. Cystic change, Lipoma get degenerated by the polymer solution. Cell block requires proper, enough number of passes to be taken. Sample should be fixed overnight in cell block fixative (60ml of ethyl alcohol,40ml of formalin) to have a proper section without fragmentation.

Conclusion FNAC, MLBC and cell block techniques are useful for diagnosis of breast lesions. MLBC and cellblock help in improving diagnosis as they can be used for ICC. They also help in preoperative surgical management for carcinoma breast.

References Hegazy RA. Fine Needle Aspiration Cytology and Cell-Block Study of Various Breast Lumps. American Journal of Biomedical and Life Sciences AJBLS. 2014;2(1):8 Tse G, Tan PH, Schmitt F. Liquid-Based Cytology and Cell Block in Breast Lesions. Fine Needle Aspiration Cytology of the Breast. 2012;:43–8 Palpable Breast Lumps: Fine-Needle Aspiration Cytology versus Histopathology: a Correlation of Diagnostic Accuracy. The Internet Journal of Surgery IJS. 2009;18(1)

References Gorman BK, Kosarac O, Chakraborty S, Schwartz MR, Mody DR. Comparison of Breast Carcinoma Prognostic/Predictive Biomarkers on Cell Blocks Obtained by Various Methods: Cellient, Formalin and Thrombin. Acta Cytologica. 2012;56(3):289–96 S KK, Gupta N, Rajwanshi A, Joshi K, Singh G. Immunochemistry for oestrogen receptor, progesterone receptor and HER2 on cell blocks in primary breast carcinoma. Cytopathology. 2011Jun;23(3):181–6.

CYTOLOGY SECTION – DEPARTMENT OF PATHOLOGY THE IHC TEAM THE CYTOLOGY TEAM CYTOLOGY SECTION – DEPARTMENT OF PATHOLOGY JSS MC, JSS UNIVERSITY, MYSORE