European Journal of Cardiovascular Medicine

Breast lesions are a common cause of hospital visits among women and encompass a broad range of pathological conditions, including inflammatory, benign proliferative, and malignant disorders.1,2 While most palpable breast masses are benign, differentiating them from malignant lesions remains a clinical priority because breast cancer continues to be a significant public health challenge. Globally, breast cancer is the most frequently diagnosed malignancy in women, and in India, its incidence has risen steadily over the past two decades, making it the leading cancer among females.3 Early diagnosis plays a pivotal role in reducing disease-related morbidity and mortality by enabling prompt and appropriate treatment.

The diagnostic evaluation of breast lesions relies on the principle of triple assessment, which combines clinical examination, radiological imaging, and pathological evaluation. Among the available pathological techniques, fine-needle aspiration cytology (FNAC) has gained widespread acceptance as an effective first-line investigation.4,5 It is a minimally invasive, safe, inexpensive, and rapid procedure that can be performed in the outpatient department with minimal patient discomfort.6 In experienced hands, FNAC demonstrates high sensitivity and specificity and provides reliable cytomorphological information for distinguishing benign from malignant lesions. Furthermore, it helps reduce unnecessary surgical biopsies and expedites clinical decision-making, particularly in resource-limited healthcare settings.

Recognizing the need for standardized reporting, the International Academy of Cytology (IAC) introduced the Yokohama System for Reporting Breast Fine-Needle Aspiration Biopsy Cytopathology. This reporting system classifies breast cytology into five diagnostic categories, each associated with an estimated risk of malignancy and corresponding management recommendations.7 Standardized reporting has improved communication between pathologists and clinicians, enhanced diagnostic reproducibility, and facilitated quality assurance across institutions.

Despite the increasing use of core needle biopsy, FNAC remains an indispensable diagnostic tool, particularly in resource-constrained healthcare settings because of its simplicity, affordability, and rapid turnaround time. The present study was undertaken to evaluate the cytomorphological spectrum of breast lesions diagnosed by FNAC, classify the aspirates according to the IAC Yokohama reporting system at a tertiary care teaching hospital.

This retrospective observational study was conducted in the Department of Pathology, ESIC Medical College and Hospital, Namkum, Ranchi, after obtaining approval from the Institutional Ethics Committee. A total of 118 patients presenting with palpable breast lesions and undergoing fine-needle aspiration cytology (FNAC) between January 2024 and June 2026 were included. Written informed consent was obtained from all patients prior to the procedure. FNAC was performed by trained pathologists under aseptic precautions using a 22–23-gauge needle attached to a 10–20 mL disposable syringe. Ultrasound-guided FNAC was employed for small, deep-seated, cystic, or necrotic lesions when indicated. Aspirated material was smeared onto glass slides, with air-dried smears stained using Giemsa stain and alcohol-fixed smears stained with Papanicolaou and Hematoxylin and Eosin (H&E) stains. All cytological smears were independently evaluated by cytopathologists. The cytomorphological findings were classified according to the International Academy of Cytology (IAC) Yokohama System for Reporting Breast Fine-Needle Aspiration Cytopathology, which categorizes breast lesions into five diagnostic groups: C1 (insufficient), C2 (benign), C3 (atypical), C4 (suspicious for malignancy), and C5 (malignant). The study aimed to evaluate the cytomorphological spectrum of breast lesions using FNAC and categorize them according to the IAC Yokohama reporting system.

A total of 118 patients with breast lesions were included in the study. Females constituted the majority of the study population (112, 94.9%), while males accounted for 6 (5.1%) cases. The 20–29 years age group represented the largest proportion of patients (64, 54.2%), followed by the 10–19 years age group (24, 20.3%). Patients aged 30–39, 40–49, and >50 years constituted 8.5%, 10.2%, and 6.8% of cases, respectively. Anatomically, the right breast was more frequently involved (66, 55.9%) than the left breast (38, 32.2%), while 14 (11.9%) patients had bilateral lesions.

Based on the IAC Yokohama System for Reporting Breast Fine-Needle Aspiration Cytopathology, the benign (C2) category predominated, accounting for 103 (87.3%) cases. Fibroadenoma was the most common cytological diagnosis (70, 59.3%), followed by cysts/fibrocystic changes (15, 12.7%). Other benign lesions included acute mastitis, breast abscess, granulomatous mastitis, fat necrosis, galactocele, and gynaecomastia. One case (0.9%) was categorized as C1 (insufficient), 2 (1.7%) as C3 (atypical), 4 (3.4%) as C4 (suspicious for malignancy), and 8 (6.8%) as C5 (malignant), all of which were diagnosed as invasive ductal carcinoma. Benign lesions were predominantly observed in patients younger than 30 years, whereas suspicious and malignant lesions occurred mainly in patients aged 40 years and above, with the highest number of malignant cases recorded in patients older than 50 years.

Table 1: Distribution of Patients According to Gender

Table 2: Distribution of Patients by Age Group

Table 3: Distribution of Patients According to Anatomical Site

Table 4: Distribution of Patients According to the Cytological Spectrum of Breast Lesions as per the IAC Yokohama System

Table 5: Distribution of Breast Lesions According to Age groups and IAC Yokohama System Categories

Breast lesions are among the most frequent causes of clinical presentation in women and cover a wide pathological spectrum ranging from inflammatory and benign proliferative conditions to malignant tumours. Although most palpable breast lumps are benign, excluding malignancy is essential due to the rising global and national burden of breast cancer. In this context, FNAC serves as a valuable initial diagnostic tool for evaluating breast lesions.

In the present study, a clear female predominance was observed, reflecting the expected distribution of breast pathology. The highest number of cases occurred in the 20–29 years age group, indicating that benign breast conditions are more common in younger individuals. This age-related pattern supports the well-established observation that lesions such as fibroadenoma are frequent in reproductive age groups, while malignant lesions tend to increase with advancing age. This findings are in accordance with results shown by Ahmad F et al8, Kochhar et al9, Khanzada et al10, Iyer et al11, Akhator et al12, and Irabor et al13.

Right-sided breast involvement was slightly more common than left-sided involvement, while bilateral lesions were less frequent. This distribution is consistent with several published studies, similar to study conducted by Binayke R et al14, although no definite clinical or pathological explanation exists for laterality differences.

Cytological evaluation using the IAC Yokohama System showed that the majority of cases belonged to the benign category (C2). Fibroadenoma was the most frequently diagnosed lesion, followed by fibrocystic changes. This predominance of benign lesions is in agreement with most FNAC-based studies done by Kamatar P et al15, Apuroopa M et al16, Shankar M et al17, and Guru A et al18.which consistently report fibroadenoma as the most common breast lesion. Inflammatory and other benign conditions formed a smaller proportion of cases.

The proportion of inadequate (C1), atypical (C3), suspicious (C4), and malignant (C5) categories was relatively low. All malignant cases were diagnosed as invasive ductal carcinoma. The distribution of cytological categories demonstrated a strong association with age, with benign lesions predominantly seen in younger patients and malignant lesions occurring mainly in those above 40 years, particularly after 50 years of age. This trend highlights the importance of age as a significant factor in risk stratification.

The use of the IAC Yokohama System provided a standardized approach for reporting breast FNAC, improving diagnostic clarity and communication between pathologists and clinicians. It also allows risk-based categorization, which aids in guiding further management. FNAC continues to be a reliable, minimally invasive, and cost-effective diagnostic method, especially in resource-limited settings where rapid decision-making is essential.

Overall, the findings emphasize that most palpable breast lesions are benign, particularly in younger patients, while the likelihood of malignancy increases with age. Correlation of cytological findings with clinical and radiological features remains essential for accurate diagnosis and appropriate patient management.

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