Impact of Implementing Grading Fine Needle Aspiration Cytology in Diagnosis of Breast Cancer amongst Sudanese Women

Abstract

ine-needle aspiration cytology (FNAC), as practiced today is an interpretive art with histopathology as its scientific base.1 FNAC is a simple and less traumatic diagnostic technique which offers many advantages both to the patient and surgeon. FNAC of the breast has been shown to be a safe and accurate technique, although many surgeons question whether it is reliable enough to replace excisional biopsy. If FNA is followed by excisional biopsy for confirmation, it would seem that the cost of diagnostic work-up would be increased. However, the major economic benefit of FNA is not that it replaces excisional biopsy, but that it allows the surgeon to decide which patients should have FNA or excisional biopsy.2 FNAC has an average sensitivity of 87%, specificity of 99%.3 A problem inherent to this technique is to obtain an insufficient specimen.4 Female breast cancer is by far the leading cancer in the Sudan, which has been recognized as an important health problem, which is associated with a high rate of mortality and morbidity. The highest percentages were recorded in 1998 (38.4%) of all female cancers (as reported by Radiation Isotope Center Khartoum).5 On the other hand, most of these cases present with late stages of the disease. In view of that, the implementation of simple, less invasive and inexpensive dealings is important for early detection and planning for an appropriate treatment of the disease. Clinical examination and mammography alone or together do not identify all malignant breast lesions. Because of this, in order not to miss malignancy, all solid breast lesions require microscopic diagnosis. Open biopsy is the most sensitive diagnostic technique, but it is less desirable because approximately 20-25% of clinically suspicious prove to be malignant on histology.3 This means that about 75% of the biopsies performed for benign lesions. Therefore, the application of less invasive, quick and cheap technique is very consequential, particularly in a country like the Sudan, where many patients present from remote areas with poor health services. For that reason, the incidence and mortality of breast cancer are high, remarkably constant and the frequency is increasing, particularly amongst younger women. This study evaluated the possibility of introducing a new system (GFNAC) for the diagnosis of palpable breast lumps, as a preoperative diagnostic tool, and to compare it to CFNAC. The findings of this new system (GFNAC) were compared to histopathology of the gold standard.