Correlation of fine needle aspiration cytology with histopathological diagnosis in assessing breast lumps at a tertiary care hospital

Background: Breast cancer is one of the most common malignancies in women worldwide (22%) and India ranks the second after cervical cancer. The diagnostic accuracy of FNAC increases to 99% when it is combined with clinical and radiological examination. In this study, authors plan to correlate the cytological findings with histopathological examinations for breast lesions and determine the accuracy of fine needle aspiration cytology in the diagnosis of breast lesions.Methods: It is a retrospective study carried out in the Department of Pathology at a Tertiary Care Hospital. All the FNAC results of breast lesions during the one year period were collected. Gauge needle maximum of 3 passes were made and the slides were fixed in 70-80% alcohol and stained with routine haematoxylin and eosin stain.Results: Among 200 patients, 197 were females and 3 were males. Benign breast lesions were found in 158 cases; among which fibroadenoma was the commonest lesion. Malignancy was observed in 25 cases. Two cases of phyllodes tumour were incorrectly reported as fibroadenoma on cytology. Of 12 cases which were diagnosed to have atypical lesions, 4 cases were papillary neoplasm, and 8 cases were atypical ductal hyperplasia.Conclusions: This study concludes that breast FNAC is a reliable, easy, cheap and effective procedure for the diagnosis. It reduces the need of core needle biopsies and very well correlated with histopathological examination. FNAC differentiates non neoplastic from the neoplastic by which it reduces the patient’s anxiety and helps the surgeons in planning the mode of treatment

Correlation of histologic grade of breast carcinoma with hormone receptor status in a tertiary care hospital

Background: Breast cancer is one of the most common malignancies affecting the female population worldwide. Prognosis and management of breast cancer are influenced by variables such as stage, grade, hormone receptor status of oestrogen(ER), progesterone(PR) and Human epidermal growth factor receptor2 (HER2/neu) overexpression. Aim to correlate grade of tumour with ER, PR and HER2/neu receptor status of breast carcinoma.Methods: A prospective study was done in Pathology department, MGM Medical College and Hospital, Aurangabad, Maharashtra for one year. Out of 65 cases studied, 28 cases were biopsy and 37 cases were modified radical mastectomy specimens. All samples were subjected for routine histological examination and immunohistochemical analysis.Results: Age of patients ranged from 30 to 82 years; 60% of tumours were right sided; 46% were involving upper outer quadrant; 58% were radiologically BI-RADS 4; 46% tumours were histopathologically grade 2 and 90% were invasive breast carcinoma, not otherwise specified. By immunohistochemistry, 60% were ER/PRpositive, 9% HER2/neu positive, 26% triple negative and 5% HER2/neu equivocal. In our study, out of 13 grade 1 tumours, 100% were ER/PRpositive and HER2/neu negative; thus an inverse relationship was found between HER2/neu and ER/PR receptors. Also 70% of triple negative tumours were grade 3 which have an aggressive behaviour compared to other subtypes and were common in premenopausal women.Conclusions: Assessment of hormone receptors for clinical management of breast cancer patients is strongly advocated to provide prognostic information and best therapeutic options. A significant correlation was observed between hormonal receptor status and the grade of tumour

Study of reactivity pattern of hormone receptors in patients with breast cancer at a tertiary care hospital, Aurangabad, India

Background: Breast cancer is one of the most common malignancies affecting the female population worldwide. Prognosis and management of breast cancer are influenced by variables such as stage, grade, and hormone receptor status. Tumours that express ER and/or PR have a better prognosis and most of them respond well to hormonal therapy. In addition to hormone receptors, HER2 has emerged in recent years as an important independent predictive marker.Methods: All surgically operated female cases of breast carcinoma which were submitted for immunohistochemistry test for estrogen, progesterone and human epidermal growth factor receptor-2 in the Department of Pathology, MGM Medical College, Aurangabad for the duration of December 2015 to October 2017 were included in this prospective study. A total of 50 patients were taken up for the study.Results: The maximum age of the patients were in the 4th -5th decade and were mostly premenopausal. The tumour was maximum involving the right breast, upper outer quadrant and were BI-RADS 4. Majority were grade 2 and were invasive ductal carcinoma. Hormone receptor status showed ER positivity 48%, PR positivity 46% and HER2 positivity 28%.Conclusions: So, to conclude, immunohistochemical analysis of ER, PR and HER2 receptors is widely available at a reasonable cost and provides valuable prognostic, predictive and therapeutic information. Although we could see different patterns of hormonal receptor status, irrespective of the histological grade, type and lymph node status in our study, HER2 testing along with ER/PR status should be performed routinely in all the patients diagnosed of breast cancer as this will help the clinicians to manage the patients further

Correlation of histologic grade of breast carcinoma with hormone receptor status in a tertiary care hospital

Background: Breast cancer is one of the most common malignancies affecting the female population worldwide. Prognosis and management of breast cancer are influenced by variables such as stage, grade, hormone receptor status of oestrogen(ER), progesterone(PR) and Human epidermal growth factor receptor2 (HER2/neu) overexpression. Aim to correlate grade of tumour with ER, PR and HER2/neu receptor status of breast carcinoma.Methods: A prospective study was done in Pathology department, MGM Medical College and Hospital, Aurangabad, Maharashtra for one year. Out of 65 cases studied, 28 cases were biopsy and 37 cases were modified radical mastectomy specimens. All samples were subjected for routine histological examination and immunohistochemical analysis.Results: Age of patients ranged from 30 to 82 years; 60% of tumours were right sided; 46% were involving upper outer quadrant; 58% were radiologically BI-RADS 4; 46% tumours were histopathologically grade 2 and 90% were invasive breast carcinoma, not otherwise specified. By immunohistochemistry, 60% were ER/PRpositive, 9% HER2/neu positive, 26% triple negative and 5% HER2/neu equivocal. In our study, out of 13 grade 1 tumours, 100% were ER/PRpositive and HER2/neu negative; thus an inverse relationship was found between HER2/neu and ER/PR receptors. Also 70% of triple negative tumours were grade 3 which have an aggressive behaviour compared to other subtypes and were common in premenopausal women.Conclusions: Assessment of hormone receptors for clinical management of breast cancer patients is strongly advocated to provide prognostic information and best therapeutic options. A significant correlation was observed between hormonal receptor status and the grade of tumour

Histomorphological Comparison of Tissues Fixed in Conventional Formalin and Eco-friendly Jaggery Solution: A Cross-sectional Study

Introduction: Tissue fixation is an essential step in the microscopic preparation of tissues to preserve them by preventing autolysis, bacterial putrefaction, and increasing the tissue's refractive index. The conventional fixative used is 40% formaldehyde. Short-term exposure to formaldehyde can cause irritation to the eyes and respiratory tract, leading to breathlessness and coughing. The International Agency for Research on Cancer (IARC) has classified formaldehyde as a Class 1 human carcinogen capable of potentially causing various neoplasms, including nasopharyngeal carcinoma. Therefore, an innovative approach is being explored to replace formalin with harmless and eco-friendly jaggery. Jaggery possesses cytoprotective, antioxidant, and tissue-preservative properties. At a low pH, the fructose in jaggery breaks down into aldehydes, which cross-link with tissue amino acids, resulting in tissue fixation similar to formaldehyde. Aim: To compare the histological and gross morphological features of tissues fixed in formalin and jaggery. Materials and Methods: This cross-sectional study was conducted in Department of Pathology of a tertiary care centre. Surgical specimens obtained fresh, which were not suspicious of malignancy, were included. A sample size of 23 was selected. Surgical specimens already placed in formalin were excluded. A 30% jaggery solution was prepared by dissolving 300 grams of finely powdered jaggery in 1000 mL of distilled water, which was then filtered using filter paper. A 40% formaldehyde solution was used to prepare a 10% formalin fixative. Tissue bits from each specimen were cut into two halves and placed in formalin and jaggery separately. After 24 hours of fixation, the tissue bits were evaluated for gross morphological features, including tissue shrinkage, consistency, and colour. Tissue shrinkage was classified as mild, moderate, or marked, while consistency ranged from soft to firm to hard. The colour of the specimens varied case by case. Stained slides from jaggery-fixed and formalin-fixed tissues were assessed for histological parameters, such as nuclear details, cytoplasmic details, cellular outline, and overall staining quality. A blinded method was used to compare the stained slides using a microscope. Ratings were assigned to each case on a scale of 1-4. The data were statistically analysed using R software. Results: When comparing the formalin-fixed and jaggery-fixed specimens, no significant differences were observed in gross morphological features. All jaggery-fixed specimens appeared brown grossly. Histological features also showed no significant difference (p-value>0.05) except for cytoplasmic details. Therefore, it was observed that tissue preservation using the jaggery solution was comparable to that of formalin. Conclusion: The tissue-preservative properties of jaggery are on par with formalin. Hence, jaggery solution can be used as an eco-friendly substitute for formalin. Further research with larger sample sizes can pave the way for the effective replacement of hazardous formalin with natural jaggery