Comparison of Cytological versus Histopathological Grading of Invasive Ductal Carcinoma of the Breast with Correlation of Lymph Node Status

Background: Invasive ductal carcinoma is one of the most common type of tumors in females, constituting a single large group of breast cancers. There are various prognostic factors, of which tumor grade, size and axillary lymph node metastasis are among the important ones. Fine needle aspiration cytology is a commonly used diagnostic technique in the initial evaluation of breast lumps. In the era of neoadjuvant chemotherapy, the material obtained from fine needle aspiration cytology is often the only baseline morphology available for future evaluation. Therefore the assessment of cytological grade in fine needle aspiration cytology samples is useful. In addition, correlating cytological grade with axillary lymph node status is indicative of tumor aggressiveness. This study correlates the cytological grade with histological grade and axillary lymph node status. Methods: Patients with cytological diagnosis of ductal carcinoma who underwent subsequent resection and axillary clearance over a period of five years were included in the study. Fine needle aspiration cytology smears were graded by Robinson’s method and compared with the Modified Bloom Richardson’s histopathological grading and axillary lymph node metastasis. Results: There were a total of 98 cases of invasive ductal carcinoma. Patients’ ages ranged from 28 to 98 years with a mean of 52.17 years. In terms of cytology, there were 22 (22.4%) grade I cases, 61(62.2%) grade II, and 15 (15.3%) grade III. For histopathology, 22 (22.4%) were grade I, 56 (57.1%) were grade II, and 20 (20.4%) were grade III. In 76 (77.5%) cases the cytological grade correlated with histological grade, but did not show any significant positive correlation with axillary lymph node metastasis. Conclusion: Cytological grade can be used as a predictor of histological grade, but may not predict axillary lymph node metastasis in patients with invasive ductal carcinomas.