Jemds.

com Original Research Article

A Correlative Study of Fine Needle Aspiration Cytology

with Histopathology of Female Breast Lesions
Phirthangmoi Fimate1

1Department of Pathology, Jawaharlal Nehru Institute of Medical Sciences (JNIMS), Imphal, Manipur, India.

ABSTRACT

BACKGROUND
Breast lesions remain a major public health problem worldwide. Fine needle Corresponding Author:
aspiration cytology (FNAC) has become one of the first-line investigations for the Dr. Phirthangmoi Fimate,
Ebenezer Villa,
diagnosis of breast lumps. Although one of the major goals of FNAC is to
Near Shija Hospital,
differentiate benign from malignant lesions, in certain cases, this may not possible Langol, Imphal West-795004,
due to a lack of uniformity with regards to the reporting terminology used in breast Manipur, India.
cytology by pathologists worldwide, resulting in poor communication of results E-mail: drmoite@gmail.com
among health-care providers. The present study aims to evaluate the role and
diagnostic accuracy of FNAC in the evaluation of breast lesions using the National DOI: 10.14260/jemds/2020/246
Cancer Institute (NCI) recommended terminology by correlating with
histopathological examination (HPE) results. Financial or Other Competing Interests:
None.

METHODS How to Cite This Article:

In this retrospective study conducted over a period of two years, a total of 382 Fimate P. A correlative study of fine needle
female patients with breast lesions underwent FNAC and was categorized according aspiration cytology with histopathology of
to the NCI guidelines. Of these, 156 cases had histopathological follow-up and their female breast lesions. J. Evolution Med.
FNAC diagnoses were compared. The sensitivity, specificity, positive predictive Dent. Sci. 2020;9(14):1135-1139, DOI:
value (PPV), and negative predictive value (NPV) along with 95% confidence 10.14260/jemds/2020/246
interval (95% CI) and accuracy of FNAC were calculated.
Submission 30-01-2020,
Peer Review 15-03-2020,
RESULTS Acceptance 21-03-2020,
Among the 156 cases, none were unsatisfactory (C1); 105 (67.1%) were benign Published 06-04-2020.
(C2); 7 (4.4%) were atypical but probably benign (C3); 2 (1.1%) were suspicious
favouring malignancy (C4); 43 (27.4%) were malignant (C5). Cyto-histopathological
correlation was carried out. Of categories C2 and C3 (total of 112 cases), 109 were
confirmed as benign (true negative) and the remaining 3 cases turned out to be
malignant (false negative). Of categories C4 and C5 (total of 45 cases), all cases were
confirmed as malignant (true positive) and none were benign (false positive). The
present study showed a sensitivity, specificity, PPV, NPV and accuracy of 93.62%
(95% CI, 82.46%–98.66%), 100% (95% CI, 96.67%–100%), 100% (95% CI, 92.5%–
99.6%), 97.32% (95% CI, 92.4%–99.09%) and 98.08% respectively.

CONCLUSIONS
Our study concluded that FNAC is a rapid and effective method, and reporting of
smears using NCI guidelines highly correlated with the histopathological diagnosis.

KEY WORDS
Breast Lesions, Cytodiagnosis, Histopathologic Diagnosis, Fine-Needle Aspiration
Cytology, Histopathological Examination, National Cancer Institute

J. Evolution Med. Dent. Sci./eISSN- 2278-4802, pISSN- 2278-4748/ Vol. 9/ Issue 14/ Apr. 06, 2020 Page 1135
Jemds.com Original Research Article

BACKGROUND FNAC demands high specimen quality and experience on part

of both the aspirator and the cytopathologist.9
Accurate pathological diagnosis is crucial for further
Lesions of the breast constitute a major public health
treatment and estimation of an outcome. One of the major
problem worldwide, both in developed as well as in
goals of FNAC is to differentiate benign from malignant
developing countries.1-3 A palpable breast lump, whether
lesions. However, in certain instances, differentiation of
benign or malignant, is a cause of great anxiety to the
benign from malignant lesion is not possible due to
patient.4 Thus, the need arises to distinguish benign from
significant overlap on smears and also when there is a
malignant lesions, prior to definitive treatment. Fine needle
paucity of cells. To address these cytomorphologic
aspiration cytology (FNAC) is a simple procedure that
uncertainties and to bring a higher degree of uniformity to
involves passing a fine (22-24 G) needle fitted to an air-tight
the reporting terminology so as to limit false positive or false
syringe, through the skin, to sample fluid or tissue from a
negative results, the National Cancer Institute (NCI) proposed
solid or cystic mass. The extracted material is skilfully
five diagnostic categories, based on the National Health
smeared onto a glass slide and is air- dried or fixed, stained
Services Breast Screening Programme (NHSBSP) of Britain
rapidly, studied and diagnosis rendered promptly.5
proposed in 1996 namely, C1, C2, C3, C4 and C5.1,4
Investigations like ultrasonography and mammography
In the present study, we aim to evaluate the role and
are used as an adjunct to FNAC, with biopsy as the standard
diagnostic accuracy of FNAC in the evaluation of breast
procedure in the diagnosis of breast lesions. The triple test lesions using the NCI recommended terminology by
approach, which comprises clinical breast examination, correlating with histopathological results.
radiological imaging (sonography and mammography), and
pathological assessment with FNAC however remains an
excellent tool in the initial assessment of palpable breast
ME T H O D S
lumps as well as for screening asymptomatic patients.1,6,7 But
each of these techniques have their own advantages and
limitations.6,8,9 Ethical clearance was applied for and obtained from the
Histopathologic studies still remain the gold standard or Institutional Ethics Committee before the commencement of
reference point for establishing the diagnostic accuracy of the present study. A retrospective study was conducted over
cytological smears. However, surgical biopsy (either core a period of two years, i.e., between the period of January 2011
needle biopsy [CNB] or excision) results in a large burden of to December 2012. The data of all patients presenting with
surgery with major preparations, high cost (as compared to breast lump who underwent FNAC in the Cytology division of
FNAC), hospital reservations, medico-legal complications, Pathology Department, JNIMS, Manipur, during this period
technological complexities and a large staff, long tissue were retrieved and reviewed. Only the female breast cases
processing time, cumbersome, and time consuming results, were further analysed. Details concerning age, laterality and
complications, interpretations,1,9 patient discomfort such as site of the breast lesions were recorded. Available
pain, infection, bleeding and haematoma, and the risk of cytopathologic reports and slides were retrieved and the
seeding of the tumour along the needle track in case of core cytomorphological features of all the lesions were further
biopsies.6 Hence, FNAC helps to determine when the surgical studied.
approach is warranted. Informed consent had been taken. All patients had been
With the obvious advantages of ease, simplicity, rapidity, made to lie down on the examination bed and all breast lump
inexpensive and virtually painless procedure and with a high aspirates had been performed using 22-24-gauge needle and
percentage of sensitivity, specificity, accuracy and virtually no 10 mL syringe by the cytopathologist under aseptic
complications, FNAC has become a standard tool and one of precautions. The aspirated material was then smeared onto a
the first-line investigations for the diagnosis of breast minimum of 5 clean, dry and grease-free slides. One slide was
lumps.1-6,8,10,11 Moreover, FNAC is a relatively safe procedure rapidly stained with Leishman stain for a minute and
in certain circumstances like very small lesions, superficial examined for sample adequacy. Three slides were air dried
lesions, or lesions very close to the chest wall as compared to and stained with May-Grunwald-Giemsa stain. One slide was
biopsies. In addition, FNAC maintains tactile sensitivity, wet-fixed in 95% ethyl alcohol and subsequently stained with
allows multi-directional passes allowing a broader sampling Papanicolaou stain. The stained smears were then classified
of lesion, and immediate reporting whenever necessary.1 into five major diagnostic categories after screening and
FNAC is not only useful in diagnosis and further planning interpretation by applying the probabilistic approach4: These
of treatment without need for biopsy, but also helpful in were C1, Non diagnostic/unsatisfactory/unremarkable; C2,
prognostication of the tumour factors such as nuclear Benign; C3, Atypical; C4, Suspicious for malignancy; and C5,
grading, mitotic index, hormone receptor status and DNA Malignant.
contents.2 Especially in developing countries and countries Records of subsequent excisional biopsies or
with limited resources, majority of breast malignancies are mastectomies were also retrieved from the Histopathology
advanced7 and an unequivocal pre-operative diagnosis of division of Pathology Department. Specimens had been fixed
malignancy is frequently required by surgeons in order to in 10% formalin solution, routinely processed, sectioned and
justify a more intense medical evaluation for metastatic stained with haematoxylin and eosin staining methods for
disease. In such settings, FNAC serves as a cost-effective microscopic examination. The histopathologic examination
alternative to open surgical biopsy. However, successful (HPE) reports and slides were retrieved and reviewed.
Comparison was made with the corresponding cytopathology

J. Evolution Med. Dent. Sci./eISSN- 2278-4802, pISSN- 2278-4748/ Vol. 9/ Issue 14/ Apr. 06, 2020 Page 1136
Jemds.com Original Research Article
reports and codes for correlation. Patients with C2 and C3 C2 C3 C4 C5

diagnoses by FNAC and confirmed as benign on HPE were

Suspicious

Malignant
Atypical
Granulo
Lacta.
FAsis
taken as true negative, while those confirmed as malignant on Age Total %

Abs.

FCD

Gal.
FA
HPE were considered as false negative. Patients with C4 and
C5 diagnoses by FNAC but confirmed as benign on HPE were 11-20 46 2 2 0 0 1 1 0 0 0 52 13.6
considered as false positive, while those confirmed as 21-30 73 20 7 14 1 3 1 5 0 2 126 33.0
31-40 29 17 8 14 1 0 0 12 2 20 103 27.0
malignant were considered true positive. 41-50 11 8 5 21 0 0 0 4 1 22 72 18.8
51-60 2 0 1 2 0 0 0 1 1 17 24 6.3
61-70 0 0 0 0 0 0 0 0 0 4 4 1.0
71-80 0 0 0 0 0 0 0 0 0 1 1 0.3
Total 161 47 23 51 2 4 2 22 4 66 382 100.0
Statistical Analysis % 42.1 12.3 6.0 13.4 0.5 1.0 0.5 5.8 1.0 17.3 100.0
All the statistical analysis was performed using Statistical FA-Fibroadenoma, FAsis-Fibroadenosis, Abs-Abscess, FCD-Fibrocystic disease, Gal-
Galactocele, Lacta-Lactational change, Granulo-Granulomatous lesion
Package for Social Sciences Statistics (SPSS) version 20. The
Table 1. Age Distribution of Female Breast Lesions
sensitivity, specificity, positive predictive value (PPV), and
negative predictive value (NPV) along with 95% confidence Quadrant
Laterality UO UI LO LI Total %
interval (95% CI), accuracy, false positive rate, and false Right 152 (39.8%) 34 (8.9%) 18 (4.7%) 9 (2.4%) 213 55.8%
Left 111 (29.1%) 33(8.6%) 16 (4.2%) 9 (2.4%) 169 44.2%
negative rate of FNAC for diagnosing malignant breast lesions Total 263 67 34 18 382 100 %
were calculated. Qualitative data are summarized using % 68.8% 17.5% 8.9% 4.7%
UO-Upper outer, UI-Upper inner, LO-Lower outer, LI-Lower inner
frequency and percentage.
Table 2. Laterality and Quadrant

HPE
Benign Malignant
RESULTS

Cyt Diag

IDC-NOS
Granulo

IDC-Pap

MED CA

MUC CA
C

Total

Fasis

FCD
Abs

ILC
FA
There was a total of 382 cases of female breast FNAC’s during
the period of January 2011 to December 2012. Satisfactory FA 74 0 73 0 0 0 0 0 1 0 0
Abs. 5 5 0 0 0 0 0 0 0 0 0
aspirates were obtained in all of the cases. The age at Granulo 1 0 0 0 0 1 0 0 0 0 0
Fasis 2 0 0 2 0 0 0 0 0 0 0
presentation ranged from 14 to 75 years with a mean age of 2
FCD 23 0 0 0 23 0 0 0 0 0 0
34 years with SD of 11.8 years. Benign lesions were more 3 Atypical 7 0 2 0 3 0 1 1 0 0 0
4 Suspicious 1 0 0 0 0 0 1 0 0 0 0
common in 21–30 years and malignant lesions in 41–50 years 5 Malignant 43 0 0 0 0 0 41 0 0 1 1
(Table 1). All of the female patients presented with a Total 156 5 75 2 26 1 43 1 1 1 1
% 3.2 48.2 1.3 16.7 0.6 27.6 0.6 0.6 0.6 0.6
unilateral breast lump. The right breast (213, 55.8%) and the CytDiag-Cytologic Diagnosis, HPE-Histopathologic Examination, FA-Fibroadenoma,
upper outer quadrant (263, 68.8%) were most commonly Abs-Abscess, Fasis-Fibroadenosis, FCD-Fibrocystic disease, Granulo-Granulomatous
mastitis, IDC-Infiltrating duct carcinoma, NOS-Not otherwise specified, Pap-
involved. (Table 2). Among the 382 female breast FNAC cases, Papillary, ILC-Infiltrating lobular carcinoma, Med Ca-Medullary carcinoma, Muc Ca-
Mucinous carcinoma.
there were no category C1 cases (all satisfactory smears), C2
Table 3. Comparison of Cytology with Histopathology Reports
consisted of 290 (75.8%), C3 consisted of 22 (5.8%), C4
consisted of 4 (1%), and C5 consisted of 66 (17.3%) cases.
Unsatisfactory

C2 (%) Benign

Out of 290 cases of category C2, fibroadenoma (42.1%,

Suspicious

Malignant
Atypical
Number
of Cases
Year of

C1 (%)

C3 (%)

C4 (%)

C5 (%)
Study

Study

161/382) was most common lesion as shown in Table 1.

Of these 382 FNAC cases, histopathological examination
(HPE) report was documented in 156 cases with a biopsy rate
of 40.8% of which, none were C1, 105 (67.1%) were C2, 7 Ukah and
2005 1401 38 (2.7) 803 (57.3) 6 (0.4) 107 (7.6) 447 (31.9)
Oluwasola12
(4.4%) were C3, 2 (1.1%) were C4, and 43 (27.4%) were C5 Challa et al13 2010 812 8 (0.9) 314 (38.6) 27 (3.3) 12 (1.4) 451 (55.5)
as in Table 3. The comparison of these 156 cases of FNAC Sankaye et al2 2012 225 13 (5.8) 131 (58.2) 8 (3.6) 8 (3.5) 65 (28.9)
Chokshi and
diagnoses with corresponding HPE diagnoses was done. On Mehta14
2012 407 28 (6.9) 293 (71.9) 8 (2) 8 (2) 70 (17.2)

HPE, 99% (104/105) cases of C2 were confirmed as benign Singh et al15 2014 100 5 (5) 51 (51) 2 (2) 3 (3) 39 (39)
Arul and
2015 523 14 (2.7) 352 (67.3) 27 (5.2) 41 (7.8) 89 (17)
and the remaining 1 case turned out to be malignant Masilamani1
Madubogwu
(infiltrating lobular carcinoma, ILC). In C3, benign lesions et al 10
2017 110 17 46 5 4 38
were confirmed in 71.4% (5/7) and the remaining two cases Veena et al 16 2017 178 4 (2.2) 134 (75.28) 14 (7.8) 6 (3.3) 20 (11.2)
Present study 2019 382 0 290 (75.8) 22 (5.8) 4 (1.0) 66 (17.3)
(28.6%) were diagnosed to be malignant. In both C4 and C5, Table 4. Comparison of the Distribution of Various National Cancer
all the cases were correctly cytodiagnosed as malignant with Institute Guidelines Comparison of Present Study with Published Studies
a cyto-histological concordance of 100% (45/45). The most
Year of No. of Benign No. of Malignant
common malignant lesion noted in C5 on HPE was invasive Study
Study Cases (%) Cases (%)
Total
ductal carcinoma-not otherwise specified (IDC-NOS, 43/47, Ukah and Oluwasola12 2005 126 (50.4) 124 (49.6) 250
Nguansangiam et al17 2006 102 (56) 80 (44) 182
91.5%). (Table 3) Sankaye and Dongre2 2012 31 (40.8) 45 (59.2) 76
The present study showed a sensitivity of 93.62% (95% Yusuf and Atanda18 2012 117 (58.5) 83 (41.5) 200
Arul and Masilamani1 2015 198 (69.2) 88 (30.8) 286
CI, 82.46%–98.66%), specificity of 100% (95% CI, 96.67%– Daramola et al6 2015 398 (91.3) 38 (8.7) 436
100%), PPV of 100% (95% CI, 92.5%–99.6%), NPV of 97.32% Madubogwu et al 10 2017 58 (52.7) 52 (47.3) 110
Veena et al 16 2017 112 (78.9) 30 (21.1) 142
(95% CI, 92.4%–99.09%), and accuracy of 98.08% for FNAC Present study 2019 109 (70) 47 (30) 156
in the diagnosis of malignant lesions. The false positive and Table 5. Comparison of Histopathological Cases
false negative rate was 0% and 6.4%, respectively. of the Present Study with Published Studies

J. Evolution Med. Dent. Sci./eISSN- 2278-4802, pISSN- 2278-4748/ Vol. 9/ Issue 14/ Apr. 06, 2020 Page 1137
Jemds.com Original Research Article
results. Factors contributing to false negative results may

Sensitivity %

Specificity %
include the small size of the lesion, hypocellularity, and

Accuracy
(95% CI)

(95% CI)

(95% CI)

(95% CI)
Year of

NPV %
PPV %
Study

Study
inadequate sampling during aspiration, histological tumour

%
types such as low nuclear grade in ILC, and
well-differentiated intracystic papillary carcinoma. All cases
Sankaye and
Dongre2
2012 88.37 96.42 97.43 84.37 91.54 from C4 and C5 was diagnosed as malignant on HPE. These
Arul and
93.1 99 97.6 97 results were considered as true positive. Both false negative
2015 (88.2%– (96.8%– (92.5%- (94.9%– 97.20
Masilamani1
95%) 99.8%) 99.6%) 97.8%)
and false positive diagnoses can be reduced by good sampling
Madubogwu et al10 2017 90 95.50 94.70 91.30 92.90 technique, proper tumour localization, triple assessment, and
Veena et al16 2017 99.23 90.17 92.19 99.01
93.62 100 100 97.32 more importantly availing expert second opinions for
Present Study 2019 (82.46%– (96.67%– (92.5%– (92.4%– 98.08 doubtful cases.
98.66%) 100%) 99.6%) 99.09%)
The present study showed a sensitivity of 93.62% (95%
Table 6. Comparison of Statistical Analyses of FNAC
of the Present Study with Published Studies CI, 82.46%–98.66%), specificity of 100% (95% CI, 96.67%–
100%), PPV of 100% (95% CI, 92.5%–99.6%), NPV of 97.32%
(95% CI, 92.4%–99.09%), and accuracy of 98.08% for FNAC
in the diagnosis of malignant lesions, comparable to other
D I SC U S SI O N published studies as in Table 6.

In the present study, benign breast lesions were more

common in 21–30 years, which was similar to studies by CONCLUSIONS
Veena et al.16 Malignant breast lesions were most common in
41–50 years, which were comparable to studies by Arul et al.1
Fine-needle aspiration cytology is a rapid and effective
The present study shows that benign lesions are common in
method for the primary categorization of palpable breast
the younger age group and malignancy rates increase with
lumps into benign, malignant, atypical, suspicious, and
increasing age of patients. The right breast (213, 55.8%) was
unsatisfactory categories. Benign breast lesions are common
found to be more commonly involved in the present study,
than malignant lesions, fibroadenoma is the most common
which was in contrast to some published findings1,2; however,
benign breast lesion, whereas IDC accounts for the highest
the upper outer quadrant (263, 68.8%) was the most
number of malignant lesions. Histological correlation
common location which is similar to findings by the same
indicated FNAC to be a good diagnostic tool.
researchers.1,2
The distribution of the FNAC diagnoses of breast lesions
using NCI guidelines (1996) in our institution as compared
with published studies is shown in Table 4. Categories C2 to REFERENCES
C5 of our study were comparable to frequencies found in
most published studies. In the present study, there were no [1] Arul P, Masilamani S. Application of National Cancer
C1 categories, since rapid stain was conducted for all cases to Institute recommended terminology in breast cytology. J
determine specimen adequacy; Categories C2 and C5 are Can Res Ther 2017;13(1):91-6.
straightforward and has been associated with a high degree [2] Sankaye SB, Dongre SD. Cytological study of palpable
of diagnostic accuracy as was observed in the present study breast lumps presenting in an Indian rural setup. Indian J
(99% and 100% respectively). However, the interpretation of Med Paediatr Oncol 2014;35(2):159-64.
C3 and C4 are difficult and confusing because they do not [3] Chaudhury SMSA, Alam MK, Haque MS. The role of FNAC
have strict criteria for diagnosis. Some researchers have in diagnosis of breast disease at different ages - 208
suggested clubbing ofC3 and C4 as a single term called cases. Journal of Bangladesh College of Physicians and
equivocal/suspicious category as they believe that a Core Surgeons 2012;30(3):137-40.
needle biopsy (CNB) or surgical biopsy should be done for [4] Pandya AN, Shah NP. Breast fine needle aspiration
this combined category, as the incidence of malignancy is cytology reporting: a study of application of probabilistic
significant in both subgroups. In the present study, benign approach. Indian Medical Gazette 2013: p. 54-9.
and malignant outcome of C3 was 71.4% and 28.6%, while [5] Orell SR, Sterrett GF, Whitaker D, et al. Breast. Fine
malignant outcome of C4 was 100%, which is comparable to needle aspiration cytology. 4th edn. Churchill Livingstone
large-scale studies with histopathological correlation. Since 2005: p. 165-217.
the current study showed 71.4% benign lesions with C3 and [6] Daramola AO, Odubanjo MO, Obiajulu FJ, et al.
100% malignancy with C4, we feel that it is still useful to Correlation between fine-needle aspiration cytology and
maintain the categories C3 and C4 separately. histology for palpable breast masses in a Nigerian
On HPE of the 156 cases, benign cases (69.9%, 109/156) Tertiary Health Institution. International Journal of
were more common as compared to malignant cases (30.1%, Breast Cancer 2015;2015:742573.
47/156). This finding was similar to various studies1,16,18,17 [7] Rupom TU, Choudhury T, Banu SG. Study of fine needle
[Table 4].The most common benign and malignant breast aspiration cytology of breast lump: correlation of
lesions on HPE was fibroadenoma and IDC-NOS respectively. cytologically malignant cases with their histological
These findings were comparable to various published findings. BSMMU J 2011;4(2):60-4.
studies.1,2,7,8,10,16,18 One case of ILC was under-diagnosed as [8] Almobarak AO, Elhassan TM, Elhoweris MH, et al.
fibroadenoma in C2, one case of IDC-NOS and papillary Cytomorphologic patterns of breast lesions in Sudanese
misdiagnosed as C3 on FNAC, contributing to false negative

J. Evolution Med. Dent. Sci./eISSN- 2278-4802, pISSN- 2278-4748/ Vol. 9/ Issue 14/ Apr. 06, 2020 Page 1138
Jemds.com Original Research Article
patients: lessons learned from fine needle aspiration sector hospital in India. Patholog Res Int
cytology. Asian Pac J Cancer Prev 2014;15(8):3411-3. 2013;2013:695024.
[9] Kumar CA, Kumar PA, Tarannum K, et al. Study of breast [14] Chokshi MH, Mehta NP. Cytological study of palpable
lesions in a tertiary care centre: a retrospective study. breast lumps (407 cases) with their histological
Med Phoenix: An Official Journal of NMC, Birgunj, Nepal correlation. Int J Med Sci Public Health 2014;3(2):181-5.
2017;2(1):48-51. [15] Singh P, Chaudhry M, Nauhria S, et al. Cytomorphological
[10] Madubogwu CI, Ukah CO, Anyanwu Snc, et al. Sub- patterns of breast lesions diagnosed on fine-needle
classification of breast masses by fine needle aspiration aspiration cytology in a tertiary care hospital. Int J Med
cytology. Eur J Breast Health 2017;13(4):194-9. Sci Public Health 2015;4(5):674-9.
[11] Tiwari M. Role of fine needle aspiration cytology in [16] Veena KL, Vani R, Jijiya BP, et al. Evaluation of breast
diagnosis of breast lumps. Kathmandu University lumps by fine needle aspiration cytology in correlation
Medical Journal 2007;5(2):215-7. with histopathology. J Cont Med A Dent 2017;5(1):63-7.
[12] Ukah CO, Oluwasola OA. The clinical effectiveness of fine [17] Nguansangiam S, Jesdapatarakul S, Tangjitgamol S.
needle aspiration biopsy in patients with palpable breast Accuracy of fine needle aspiration cytology from breast
lesions seen at the University College Hospital, Ibadan, masses in Thailand. Asian Pac J Cancer Prev
Nigeria: a 10-year retrospective study. J Cytol 2009;10(4):623-6.
2011;28(3):111-3. [18] Yusuf I, Atanda AT. Validity of fine needle aspiration
[13] Challa VR, Guru BGY, Rangappa P, et al. Cytological and cytology of the palpable breast lesions: a teaching
pathological correlation of FNAC in assessing breast hospital experience. Niger J Basic Clin Sci
lumps and axillary lymph node swellings in a public 2014;11(1):36-40.

J. Evolution Med. Dent. Sci./eISSN- 2278-4802, pISSN- 2278-4748/ Vol. 9/ Issue 14/ Apr. 06, 2020 Page 1139