Cytomorphological Patterns of Palpable Breast Lesions Diagnosed in Selected Teaching and Referral Hospitals in Kenya: A Prospective Study

Abstract

To study the patterns of breast lesions among women with palpable breast lumps presenting to fine-needle aspiration clinics.

Methods This study involved 768 women aged 16 to 97 years who presented with palpable breast lumps to fine-needle aspiration clinics (FNACs) at Kenyatta National and Nakuru Teaching and referral hospitals from September 2016 to December 2018. The study was approved by Kenyatta National Hospital–University of Nairobi Ethical Review Committee (KNH-UoN ERC); P 334/16. A structured questionnaire was used to obtain qualitative data. Fine-needle aspiration was performed after obtaining informed consent and smears were stained with both H&E and Papanicolaou stains.

Results Lesions were categorized as fibroadenoma, 287 (44.1%); ductal carcinoma, 59 (9.1%); breast abscess, 39 (6%); benign cysts, 33 (5.1%); galactocele, 32 (4.9%); fibrocystic changes of the breast, 29 (4.5%); suspicious of malignancy, 27 (4.1%); duct ectasia and inflammatory breast lesions, 24 each (3.7%); atypia, 12 (1.8%); invasive ductal carcinoma, metastatic carcinoma, and lipoma, 4 each (0.6%); anaplastic carcinoma and malignant phylloides, 1 (0.2%); and others. Out of 768 smears evaluated, 117 (15.2%) smears were nondiagnostic. The age group most affected was 20 to 34 years (47.2%) followed by 35 to 49 years (26.2%). Women between 24 and 30 years had the following frequencies: anaplastic cancer (100%), invasive ductal and metastatic cancer (50%), and suspicious of malignancy (56%).

Conclusion Fibroadenoma was the most frequent lesion followed by ductal carcinoma, breast abscess, benign cysts, and galactocele, respectively. Generally, benign lesions formed the bulk of all lesions diagnosed in the two referral facilities. From this study, it is evident that the young age group (reproductive age) is the one most affected with ductal carcinoma, anaplastic carcinoma, and invasive carcinoma. The number of nondiagnostic category was quite high and this warrants proper training and competence evaluation for the clinicians/health care workers who participate in performing fine-needle aspirate procedures.