Fine Needle Aspiration Cytology of Breast Carcinoma: A Comparative Study between Cytological and Histopathological Grading System with Lymph Node Status Assessment

Introduction: Breast carcinoma is the most common malignancy and the leading cause of death in women. Fine needle aspiration cytology (FNAC) plays a critical role in early diagnosis of any palpable breast lump. Aim and objectives: The aim of the study was to find out the utility of grading malignant breast tumours using Robinson's cytology grading on FNAC and correlating it with Modified Bloom Richardson grading along with lymph node status assessment post-operatively by histopathological examination. Materials and methods: A retrospective study was conducted; cytological smears of 30 cases of breast carcinomas on FNAC were graded according to the Robinson's cytology grading and correlated with Modified Bloom Richardson histopathological grading system over a period of 1 year. Results: There were a total of 28 (93.33%) cases of invasive ductal carcinoma, 1 case of mucinous carcinoma and 1 case of Metaplastic carcinoma. All patients were females with a mean age of 52.8 years. The correlation showed 85.71% concordance between the two grading systems with a 93.33% agreement and an observed weighted Kappa value of 0.916 implying a substantial strength of agreement. Chi-square statistical test performed for lymph node metastasis with grade of the tumor was statistically significant with a p-value of 0.0189 (p<0.05). Conclusion: Cytological grading of malignant breast carcinoma aspirates will help in the management and planning future treatment including preoperative neoadjuvant chemotherapy. We recommend it to be followed by all cytopathologists, in order to bring uniformity in the reporting of breast FNAs for grading the malignant lesions.