Clinicopathological Correlation of Axillary Masses – Importance of Fine Needle Aspiration Cytology as a Diagnostic Modality

Introduction: The axilla, a triangular area located between the upper arm and thorax, contains blood vessels, nerves, lymph nodes, and fat. The most common palpable axillary masses are usually lymph nodes. However, axillary swellings can also arise from the various mesenchymal tissues present in the axillary area. Fine needle aspiration cytology (FNAC) is a relatively safe, quick, easy and a cheap diagnostic tool to decipher the benign or the malignant nature of the swelling. Although some studies have used ultrasonographic imaging techniques, alone others have used FNAC with or without ultrasound guidance to improve the detection of axillary masses. This study was conducted to document the spectrum of lesions encountered in a tertiary care center in FNAC of axillary lesions. Awareness of the various disease entities that can cause axillary masses help in their differential diagnoses. Materials and Methods: A total of 75 cases of axillary swelling which were referred for FNAC to the Department of Pathology, were evaluated. All of these patients presented with superficial palpable swelling in the axilla. The clinical diagnoses were confirmed by cytology. FNACs were done and both air dried and alcohol-fixed smears were prepared and stained with May Grunwald Giemsa, hematoxylin and eosin, Zeihl Neelsen, and Papanicolaou stains. The adequacy of the diagnostic material and the results of FNAC were reported the same day. Results: Out of the total of 75 cases of axillary swellings on which FNAC were done and evaluated, there were 24 males and 51 females. The clinical diagnoses were confirmed by cytology. Reactive lymphadenitis (30.6%) was the most common cytological diagnosis followed by lipoma (21.3%). In 42 cases (56%), the clinical diagnoses did not match with the cytological diagnoses. Most of the discrepancies were seen in the cases with the clinical diagnosis of tubercular lymphadenitis. Out of the 23 cases clinically suspected as tubercular lymphadenitis, only four cases showed the cytological findings consistent with tubercular lymphadenitis. The rest 19 cases showed findings consistent with reactive lymphadenitis (14 cases) and acute suppurative lymphadenitis (five cases). There were 18 cases with clinical suspicion of metastases from carcinoma breast to the axillary lymph nodes. Out of these, only nine cases showed cytopathological features of metastasis from carcinoma breast, whereas the remaining nine showed features of reactive lymphadenitis. Lipoma was clinically suspected in 24 cases out of which 16 cases had the cytological features of lipoma. Nine cases were clinically suspected as lymphadenopathy, out of which only three cases showed features of granulomatous lymphadenitis and rest of the cases had variable findings. There were few rare findings such as Schwannoma (two cases), pilomatricoma (one case), and fibroadenoma of ectopic breast (three cases). The diagnostic accuracy was 44% and sensitivity was found to be 44%. The low sensitivity was due to the discordance between the clinical and cytological diagnoses. Conclusion: Exploration of axillary swellings could result in unmasking of sinister findings and it can be said that all axillary lesions are not just lymph nodes. FNAC being a rapid and minimally invasive 1Assistant Professor, Department of Pathology, ESI-PGIMSR, ESIC Medical College and ESIC Hospital & ODC (EZ), Joka, West Bengal, India, 2Associate Professor, Department of Pathology, Gujarat Adani Institute of Medical Sciences, Bhuj, Kuchch, Gujarat Address for correspondence: Aniruna Dey, Department of Pathology, ESI-PGIMSR, ESIC Medical College and ESIC Hospital & ODC (EZ), Joka, West Bengal, India. Phone: +91-8902424614. E-mail: anirunad@gmail.com Access this article online Quick Response Code: Website: www.jmsh. ac.in O R IG IN A L A R T IC L E procedure can help as a diagnostic tool in such cases.