Study of breast lump of 2246 cases by fine needle aspiration.

The purpose of this study was to analyze breast lesions causing breast lump with special reference to patients younger and older than 30 years of age diagnosed by fine-needle aspiration (FNA) and to evaluate the histology of the cases diagnosed as suspicious of malignancy in FNA. All patients who underwent FNA during four years period (2000-2004) were included in this study. The FNA procedure was performed and interpreted by the experienced pathologists. Histological evaluation of the suspicious cases in FNA was done and was based on excisional biopsy or mastectomy specimen. Out of 2246 FNA performed, 1840 were diagnosed as non-malignant, 6 atypical ductal hyperplasia, 52 suspicious of malignancy and 348 as malignant. The most common non-malignant lesions included 975 (43%) fibroadenosis, 180 (8%) fibroadenoma, 126 (6%) abscess and 96 (4%) fibrocystic changes. The patients were further divided into two groups: group I consisted of 918 patients aged 30 years and younger and group II consisted of 1328 patients above 30 years. In group I, 444 (48.4%) were diagnosed as fibroadenosis and only 15 (1.6%) cases were malignancies. In group II 531 (40%) were fibroadenosis and 333 (25%) were malignant. Patients more than 30 years old had significantly higher malignancy diagnoses (P<0.001). The odds of being diagnosed as malignant tumor among the higher age group patients (>30 years) is 21 times larger (confidence interval 12.4, 35.6) than the younger patients (<30 years). In 63% (27/43) of the suspicious cases, malignancy was diagnosed in histological examination. Cancer and Fibroadenosis are two most common causes of breast lumps in Nepal. Incidence of malignancy is significantly lower in patients aged 30 years and younger than in patients aged older than 30 years. Suspicious FNA cases should be evaluated histologically to rule out malignancy.