Fine needle aspiration cytology in the diagnosis of tuberculous mastitis

OBJECTIVE: To study the relationship between granulomas in the breast and tuberculous mastitis. STUDY DESIGN: Retrospective analysis of 22 breast aspirates that showed epithelioid cell granulomas. The aspirates were reviewed and the cytomorphologic findings summarized. RESULTS: Aspiration cytology revealed epithelioid cell granulomas along with giant cells, necrosis and inflammatory cell infiltrate. Overall acid-fast bacillus (AFB) positivity was 22.7%. AFB positivity was greater in the presence of necrosis when epithelioid cells were absent. CONCLUSION: In a country like India, the diagnosis of granulomatous mastitis must be made with caution, even in the absence of AFB. Only after a sufficient trial of antituberculosis treatment has been given and the patient fails to respond should an alternative diagnosis be suggested.