THE DIAGNOSTIC UTILITY OF CELL BLOCK IN FINE NEEDLE ASPIRATION CYTOLOGY OF PALPABLE BREAST LESIONS A PROSPECTIVE STUDY

Abstract

Background: Fine Needle Aspiration Cytology as a component of the Triple test in the diagnosis of breast lesions has gained acceptance among pathologists. However some limitations to the use of conventional smear (CS) alone as well as the need to reinforce diagnosis on breast cytology have prompted the advocacy for the use of Cell block (CB) technique in complementing and consolidating the diagnosis on conventional smear. The Cell blocks can also be archived for further ancillary prognostic and predictive test. Objective: The study sought to determine the diagnostic utility of cell block in fine needle aspiration cytology of palpable breast lesions Materials and Methods: The study was conducted in the FNAC clinic of the Department of Anatomic and Molecular Pathology of Lagos University Teaching Hospital. One hundred aspirates from palpable female breast lesions were subjected to diagnostic evaluation over a year period for this study. Along with the conventional smear, 10% buffered formalin as fixative was used to prepare cell block. The data was analyzed using SPSS version 20 to determine the cellularity on CS and CB as well as to identify additional yield of malignancy on cell block. Results: There was increased cellularity and an additional yield of 13% for malignancy on cell block technique. Advantages with cell block were preservation of cellular architectural pattern even with excessive blood and the limitation of cellular concentration in one field. Follow up tissue biopsies were done on 44 of these cases, showing a biopsy rate of 44%. The Sensitivity of CB vs CS was 100% vs 76.5%, while the Specificity was 100% vs 91.7%. Conclusions The cell block technique is a useful diagnostic adjuvant to conventional smear. It provides high cellularity and better morphology and cellular architectural patterns that help to complement and consolidate diagnosis on conventional smear. It provides additional yield for malignant cells with improved sensitivity and specificity.