CORRELATION BETWEEN BREAST CYTOLOGY REPORT AND BIRADS CATEGORIZATION AT SAINT PAUL’S HOSPITAL MILLENNIUM MEDICAL COLLEGE, ADDIS ABABA, ETHIOPIA

Abstract

Abstract Background: Breast cancer is the commonest cancer in women worldwide and in Ethiopia. Worldwide accepted protocol for diagnosis of breast lumps is the “Triple Assessment” encompassing; clinical examination, mammosonography and pathological diagnosis. Although many studies focusing on the diagnostic accuracy of Fine-needle aspiration and Ultrasonography were conducted globally, the correlation between the BIRADS category and Cytology report in Saint Paul’s Hospital Millennium Medical College was not well studied. Objective: To compare and correlate the Fine-needle aspiration findings of breast lesions with BI-RADS grading on ultrasound and to point out major pathologic conditions that contribute to their discordances in Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia. Methods: Prospective hospital based observational study was conducted from January to November, 2022. Data were collected from pathology and radiology departments using structured tool. Female of any age who presented at Pathology and Radiology departments for breast Ultrasound guided Fine-needle aspiration during the study period was included. Fine Needle Aspiration Cytology smears were stained by wright and Giemsa stain. FNAC results were correlated with BI-RADS categories. Result: A total of 116 cases were included and majority of the cases were in the 4th and 5th decades of life 68(58.6%). FNAC reported 82(70.68%) as benign and 21(18.1%) as malignant. BIRADs 4 accounts for 55.2% of cases, BIRADs 5 cases 7(6%) and BIRADs 1, 2 and 3 cases 43(38.9%). Sensitivity, specificity NPV, PPV and Accuracy of BIRADs categorization by ultrasound as compared to FNAC was 53.2%, 97%, 97.7%, 46.4% and 66.07%, respectively. BIRADs 5 showed 100% concordant malignant with FNAC results. BIRADs 4 was 14/62 (22.58%) concordant malignant, 40/62 (64.5%) discordant malignant Proliferative lesion without atypia, fibroadenoma, inflammatory lesions, duct ectasia and fat necrosis were the major cases that resulted in discordant malignant findings on FNAC. Conclusion: Correlation of FNAC and BIRADs categorization by imaging is essential in preoperative evaluation of breast lumps and decrease unnecessary delay of breast carcinoma cases and surgical innervations. BIRADs categorizations by ultrasound had high (97%) specificity and 97.7% of NPV. Additional diagnostic modalities like CNB should be implemented for categories with high variable sensitivity and discordant reports in BIRADs 4. Key words: Fine Needle Aspiration Cytology, Breast lesions, Mammosonography, BIRADs