Touch imprint cytology of core needle biopsy: An underused low-cost strategy for same-day breast cancer diagnosis in resource-limited settings

Introduction

Breast cancer remains a significant health burden in low- and middle-income countries (LMICs), where a considerable proportion of patients present with locally advanced disease.^1,2 Although core needle biopsy is regarded as the gold standard for establishing the diagnosis of invasive carcinoma, histopathology reports may require 10–14 days in resource-limited settings, leading to delays in the initiation of neoadjuvant chemotherapy (NACT). Such delays are clinically relevant, as studies have demonstrated an association between prolonged diagnostic and treatment intervals and inferior survival outcomes. ³

Touch imprint cytology (TIC) prepared from fresh core needle biopsy (CNB) specimens was introduced previously and shown to provide rapid and reliable diagnostic information, complementing fine needle aspiration cytology (FNAC) without compromising subsequent histopathological evaluation. ⁴ However, despite its advantages, TIC of CNB has remained underutilized. In this study, we explored its application in the context of LMICs, with the aim of assessing its potential to expedite breast cancer diagnosis and facilitate timely initiation of treatment.

Methods

Ours was a prospective, single-centre diagnostic accuracy study conducted between January and July 2025 at a tertiary government medical college in Central India. It was approved by the Institutional Ethics Committee (IEC/2025/8986)

All patients underwent ultrasound-guided core needle biopsy using a 14G needle. Multiple cores (6–8 per patient) were obtained. Immediately after biopsy, cores were gently rolled over pre-cleaned glass slides to prepare smears. Slides were fixed in 95% ethanol and stained with Haematoxylin–eosin and May–Grünwald–Giemsa methods. The same cores were preserved in formalin and submitted for routine histopathology, which served as the reference standard. TIC slides were examined by an experienced cytopathologist, and results were communicated to the clinical team within 6–8 h. Patients with TIC-confirmed carcinoma were planned for neoadjuvant chemotherapy (NACT), initiated within 24 h.

Baseline demographic, clinical, and tumour-related variables (age, tumour size, stage, and nodal status) were recorded. Diagnostic performance measures (sensitivity, specificity, and overall accuracy) of TIC were calculated using histopathology as the gold standard.

Results

Thirty consecutive female patients presenting with breast lumps clinically suspicious for carcinoma were enrolled. The mean age was 48.5 years (range, 32–67 years). Median tumour size (available in 29 patients) was 5.2 cm (range, 3–8 cm). All patients had locally advanced breast cancer: 9 (31%) stage IIIA, 15 (52%) stage IIIB, and 5 (17%) stage IIIC. Histopathology confirmed malignancy in 29 patients and benign disease in one. TIC of CNB correctly identified malignancy in 28 of 29 histologically proven malignant cases, yielding a sensitivity of 96.6%. The single benign case was accurately reported as benign, giving a specificity of 100%. Overall diagnostic accuracy of TIC was 96.7%. Same-day reporting was consistently achieved [Table 1].

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Table 1.

Clinical profile, diagnostic performance of touch imprints cytology and its impact on treatment initiation.

Parameter	Value
Age (years)	Mean 48.5 (range 32–67)
Tumour size (cm) (n = 29)	Median 5.2 (range 3–8)
Clinical stage (n = 29)	Stage III A – 09 (31%)
	Stage III B – 15 (52%)
	Stage III C – 5 (17%)
Histology	29 malignant; 1 benign
TIC – malignancy detected	28/29
TIC – benign lesion detected	1/1
Sensitivity	96.6%
Specificity	100%
Diagnostic accuracy	96.7%
Turnaround time	Same-day (within 6–8 h)
Impact on treatment	All eligible patients started NACT within 24 h

Discussion

This study demonstrates that TIC from CNB is a simple, low-cost, and highly accurate adjunct for the rapid diagnosis of breast carcinoma. With a sensitivity of 96.6% and specificity of 100%, it provided reliable same-day results while preserving tissue integrity for subsequent histopathology. A key advantage observed was the markedly reduced turnaround time, results being available within 6–8 h, thus enabling initiation of NACT within 24 h of presentation in confirmed cases. Such expedited pathways are particularly relevant for patients with locally advanced breast cancer, where treatment delays are associated with worse outcomes.

CNB remains the preferred diagnostic modality for suspected breast cancer, as it retrieves a larger volume of tissue compared to fine-needle aspiration cytology (FNAC). This gives not only a more definitive diagnosis but allows also for critical ancillary tests such as hormone receptor and HER2 analysis.

CNB is also associated with higher sensitivity and specificity, reducing the frequency of indeterminate results and enabling more accurate tumor grading and treatment planning. In this context, integrating TIC with CNB provides a dual advantage: same-day preliminary cytological diagnosis without sacrificing the advantages of comprehensive histopathological and molecular information obtainable from CNB.

Compared with performing a separate FNAC alongside CNB, TIC of CNB offers further benefits. It requires no additional invasive procedure, thereby sparing patients unnecessary discomfort and procedural risk. As it is performed directly on the biopsy cores in the laboratory, it is faster, logistically simpler, and seamlessly incorporated into existing pathology workflows. Moreover, TIC often yields more representative material in hard or desmoplastic tumours, where FNAC may be inadequate.

Importantly, in our study, preparation of TIC slides did not compromise the morphology of the core samples, ensuring that downstream histopathology and receptor studies remained unaffected.

Earlier reports have already demonstrated its diagnostic accuracy and feasibility.^4–7 Despite these advantages, TIC of CNB has remained underutilized as a potentially valuable tool. Reviving and systematically re-implementing this under-utilized technique is particularly important in LMICs, where delays in diagnosis persist.

This study has certain limitations. The sample size was modest (n = 30), and the single-centre design may limit generalizability. Inter-observer variability was not assessed, which could further validate reproducibility. However, it is not only logical and does provide best of both the techniques FNAC and CNB, without incurring additional costs or risks. TIC of CNB exemplifies the kind of simple frugal innovation in oncology which gives positive results.