FNAC was used as a tool to confirm a clinical suspicion of carcinoma, its local recurrence or metastasis without subjecting the patient to further surgical intervention. This remains one of the most important contributions of the technique from a practical point of view. Following success in this area, the interest focused on the preliminary preoperative diagnosis of all kinds of neoplastic processes, benign or malignant, in any organ or tissue of the body and on definitive, specific diagnosis in inoperable cases as a guide to rational treatment.

This development is to a large degree the result of the consistent, continuous and critical correlation between cytological assessment and histopathological diagnosis facilitated by the organisational coordination of laboratory resources.[1]. Breast lesions are one of the common conditions referred for FNAC. Breast cytology is an important part of the "Triple approach" for pre-operative diagnosis of breast lumps, along with clinical assessment and radiological imaging. The role of Fine needle aspiration cytology as a first-line investigation in diagnosing breast lesions is well documented.

Breast pathologies have a varied spectrum and range from developmental abnormalities, inflammatory lesions, and benign epithelial and stromal proliferation to various malignant neoplasms. The clinical presentation of these lesions encompasses a wide range of symptoms, the most common being palpable lumps or they may be incidental detection. [2,3]. The vast majority of the lesions that occur in the breast are benign. Much concern is given to malignant lesions of the breast because female breast cancer has now surpassed lung cancer as the leading cause of global cancer incidence in 2020, with an estimated 2.3 million new cases, representing 11.7% of all cancer cases. [4].

Breast cancer is now the most common cancer in Indian women, having recently overtaken cervical cancer.[5]. Breast cancer has ranked number one cancer among Indian females with an age-adjusted rate as high as 25.8 per 100,000 women. There is a significant increase in the incidence and cancer-associated morbidity and mortality in the Indian subcontinent as described in global and Indian studies. [6].

A minimum of 3 smears was made depending on the amount of the aspirate obtained. Two smears were fixed in 95% ethyl alcohol and stained with Papanicolaou and Hematoxylin and Eosin (H & E) stains and one smear was air-dried and stained with Giemsa stain. These smears are initially inspected and the provisional diagnosis was made by the residents posted in the cytopathology unit, final reports were then given by the cytopathologist with a minimum of 2 years of experience. In malignant and in doubtful cases a consensus report was given after consulting another cytopathologist. Ethical clearance has been obtained from the institution where the study is conducted. All the cases were analysed by obtaining the impression from the records; in case of doubt the smears were rescreened.

The data obtained regarding various variables and the final diagnosis was tabulated using Microsoft excel, and further analysis is undertaken. Data are presented as mean, range, and percentages.

A total of 1193 breast lump cases were analysed in this 3-year study, there were 19 male patients all of them presented with gynaecomastia and 1177 female patients.

The patient’s age group ranged from 12 to 86 years. The commonest age group (Table 1) with the lesions 31-40 years comprising 326 cases (27.32%) followed 21-30 years age group in the second place with 307 cases (25.7%).

Table 1. FNAC of breast lesions: age distribution

Considering the cytomorphological spectrum (Table 2), among 19 male patients all of them presented with gynecomastia, in females neoplastic (including both benign and malignant) breast lesions (77.73%) were more common than non-neoplastic breast (22.27%) lesions. In the neoplastic lesions, the benign neoplastic lesions (644 cases) were more than malignant tumors (283 cases).

[10,11,12].

The triad of a cellular smear with a bimodal benign pattern, numerous single bipolar oval nuclei and fragments of the stroma is virtually diagnostic of fibroadenoma. In the absence of stroma, numerous single bipolar nuclei are highly suggestive of the diagnosis. In the present study, fibroadenoma was the most common benign lesion which was seen most commonly in the younger [13,14,15]. The bimodal pattern of cohesive groups of epithelial cells and scattered single, bare, bipolar nuclei was the common finding in most benign smears.

Smears with stromal cellularity, atypia and mitotic activity define whether a phyllodes tumor is benign, low grade or high grade. Smears with increased stromal cellularity were labelled as phyllodes tumor. Out of 16 cases reported as phyllodes tumor in our study none of them showed nuclear atypia or mitotic activity. Among benign lesions there were also 64 cases of ductal hyperplasia which included both benign and atypical.

The benign ductal epithelial hyperplasia smears showed cell-rich smears, large sheets of cohesive epithelial cells, few single cells often in a ‘streaming’ pattern; focal crowding and overlapping of nuclei, Nuclear atypia absent Naked bipolar and myoepithelial nuclei present. Atypical ductal hyperplasia showed similar cellularity with mild to moderate nuclear atypia and few myoepithelial cells in the background. 13 cases of ductal papilloma were reported, which on smears showed complex folded and branching epithelial sheets and finger-like fragments, strands of fibrovascular stroma cores.

Maximum numbers of malignant cases were above the age group of 41 to 50 years which is similar to the results by Rachana et al. and Khan et al. [11, 16]. In the malignant category, 251 cases were of ductal carcinoma out of which 12 cases showed axillary lymph node metastasis while a study performed by Rahman MZ et al. showed 10.32 % of malignant cases with metastatic lymph nodes on FNAC. [17].

Smears of malignant cases showed moderately to highly cellular smears with loss of cell cohesion arranged in irregular clusters and single cells, Moderate to severe nuclear atypia: enlargement, pleomorphism, irregular nuclear membrane and chromatin, Fibroblasts and fragments of collagen (stromal desmoplasia) were seen in many cases.

Studies that compared FNAC to core needle biopsy for palpable breast carcinoma showed a higher sensitivity (97.5% vs. 90%) for FNAC regardless of the size of the tumour, its subtype or its degree of differentiation. [19].

In this study the most common benign neoplastic and malignant neoplastic breast lumps are fibroadenoma and infiltrating ductal carcinoma respectively. Fibrocystic disease of the breast is the most common non-neoplastic breast lump.

Many studies in the literature provide evidence that in palpable breast lump cytology reports done on the satisfactory smears by expertise could yield superior diagnostic results, and a significant advantage of FNAC is the low cost and the ability to render a diagnosis to the clinician and patient at the time of the procedure thus allowing treatment decisions to be made immediately.

The success of FNAC depends on if the sample is taken from the representative area of the lesion examined, if samples are adequate in terms of cells and other tissue components. If samples are correctly smeared and processed and accompanied by sufficient and correct clinical/radiological information.

The success of FNAC depends on if the sample is taken from the representative area of the lesion examined, if samples are adequate in terms of cells and other tissue components.

Manasa GC: Conception or design of the work, Data analysis and interpretation.

Sneha SP: Data collection, Drafting the article.

Adicherla Govardhan: Data collection.