COMPARATIVE EVALUATION OF FINE NEEDLE ASPIRATION CYTOLOGY AND TRU-CUT BIOPSY IN THE DIAGNOSIS AND GRADING OF BREAST LESIONS: A PROSPECTIVE OBSERVATIONAL STUDY
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Keywords
Breast Neoplasms; Fine-Needle Aspiration; Core Needle Biopsy; Cytological Techniques; Histopathology; Diagnostic Concordance.
Abstract
Background Accurate pathological diagnosis of suspicious breast lesions is essential for appropriate therapeutic planning. Fine needle aspiration cytology (FNAC) is a rapid and minimally invasive technique, whereas Tru-cut biopsy provides superior tissue architecture and histological grading. This study compared the diagnostic utility and grading concordance of FNAC with Tru-cut biopsy in clinically suspicious breast lesions. Methods A prospective observational study was conducted on 70 consecutive patients with clinically suspicious breast lesions between July 2024 and December 2025. All patients underwent both FNAC and Tru-cut biopsy. Cytological grading was performed using the Robinson grading system, while histological grading was assessed using the Nottingham modification of the Scarff–Bloom–Richardson grading system. Agreement between the two techniques was evaluated using Cohen's kappa coefficient. Results The highest proportion of patients belonged to the 41–50-year age group (41.4%), and females constituted 98.6% of the study population. The upper outer quadrant was the commonest site of involvement (52.9%). FNAC diagnosed malignancy in 65 (92.9%) cases, whereas Tru-cut biopsy identified 68 (97.1%) malignant lesions, with no statistically significant difference in overall diagnostic distribution (p = 0.38). Invasive ductal carcinoma (NOS) was the predominant histological subtype. Grade II tumours were the most frequent on both FNAC (61.5%) and Tru-cut biopsy (63.1%). FNAC grading showed 93.8% concordance with Tru-cut biopsy grading, demonstrating excellent agreement (κ = 0.896, p < 0.001). Conclusion FNAC demonstrated excellent concordance with Tru-cut biopsy for the diagnosis and cytological grading of suspicious breast lesions. While Tru-cut biopsy remains indispensable for definitive histopathological evaluation and tumour characterization, FNAC continues to be a valuable, rapid, minimally invasive, and cost-effective first-line diagnostic modality, particularly in resource-limited settings.