Fine Needle Aspiration Cytology in the Diagnosis of Inflammatory Lesions of the Breast with Emphasis on Tuberculous Mastitis

Fine needle aspiration cytology (FNAC) has become the first choice as a diagnostic procedure in variety of breast diseases. The technique can be successfully used to diagnose granulomas in breast aspirates and to demonstrate the presence of acid-fast bacilli. Endemicity of tuberculosis in India, calls for a high incidence of tuberculous mastitis. However the disease is often overlooked and misdiagnosed as carcinoma or pyogenic abscess. The importance of screening nipple discharge smears in suspected cases for tubercle bacilli is highlighted in this report. During a period of two years (20052006), out of a total of 471 breast lesions referred to the Department of cytology for fine needle aspiration, inflammatory lesion of breast was detected in 21 cases. FNAC was performed on all patients using a 23 gauge disposable needle and the smears prepared were air dried and fixed in methanol. One slide per case was kept unstained in all cases. Following the screening of Giemsa stained smears; the ZeihlNielsen stain (ZN stain) for acid-fast bacilli was done in suspected cases. All the patients were women with an age incidence varying from 20 to 38 years. The duration of symptoms varied from one month to five years. They presented as painless lump in breast. The aspirate was blood mixed purulent material in most of the cases. One patient presented with nipple discharge along with a subareolar lump and one patient had a periareolar lump with a discharging sinus. The findings of breast aspirates are summarized in Table 1. Epithelioid cell granulomas were seen in nine cases. The background was inflammatory (both lymphocytes and polymorphs) in most cases. Five cases showed large number of polymorphs with necrotic material in the background, while five cases had cytological features suggestive of acute over chronic inflammatory reaction. One case showed only caseous necrosis. In the patient with nipple discharge, only clumps of benign ductal cells were seen in FNA smears of the breast lump, while the smears prepared from nipple discharge showed acute over chronic inflammation and were positive for acid-fast bacilli Letters to the Editor