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Gwak H, Woo SS, Oh SJ, Kim JY, Shin HC, Youn HJ, Chun JW, Lee D, Kim SH. A Comparison of the Prognostic Effects of Fine Needle Aspiration and Core Needle Biopsy in Patients with Breast Cancer: A Nationwide Multicenter Prospective Registry. Cancers (Basel) 2023; 15:4638. [PMID: 37760607 PMCID: PMC10527552 DOI: 10.3390/cancers15184638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/05/2023] [Accepted: 09/17/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Background: Breast core needle biopsy (CNB) is preferred over fine needle aspiration (FNA) as it has higher sensitivity and specificity and enables immunohistochemical evaluation. However, breast FNA remains widely used because of its low cost, minimally invasive nature, and quick results. Studies analyzing the effects of each test on the prognoses of patients with breast cancer are scarce and controversial, and the criteria for test selection remain unknown. (2) Methods: This study included adult female patients who underwent breast cancer surgery at 102 general hospitals. The trend of breast biopsies over time was analyzed, and the prognoses of patients with breast cancer who underwent CNB and FNA were compared. (3) Results: This study included 73,644 patients who underwent FNA (n = 8027) and CNB (n = 65,617). A multivariate Cox regression analysis showed that patients diagnosed using FNA had significantly worse overall survival (OS) and breast-cancer-specific survival (BCSS) than those diagnosed using CNB. In the subgroup analysis, patients with breast imaging reporting and data system (BI-RADS) 5 lesions, palpable tumors, or centrally located tumors had significantly worse OS and BCSS with FNA than with CNB. (4) Conclusions: CNB should be performed preferentially instead of FNA in patients with BI-RADS 5 lesions and nonpalpable or centrally located tumors.
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Affiliation(s)
- Hongki Gwak
- Division of Thyroid and Breast Surgical Oncology, Department of Surgery, Hwahong Hospital, Suwon 16630, Republic of Korea;
| | - Sang Seok Woo
- Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07247, Republic of Korea; (S.S.W.)
| | - Se Jeong Oh
- Department of Surgery, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Jee Ye Kim
- Division of Breast Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul 03186, Republic of Korea
| | - Hee-Chul Shin
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 13620, Republic of Korea
| | - Hyun Jo Youn
- Department of Surgery, Jeonbuk National University Medical School, Jeonju-si 54907, Republic of Korea;
| | - Jung Whan Chun
- Division of Breast and Endocrine Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul 03080, Republic of Korea
| | - Dasom Lee
- Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07247, Republic of Korea; (S.S.W.)
| | - Seong Hwan Kim
- Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07247, Republic of Korea; (S.S.W.)
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Tam NT, Makram AM, Elsheikh R, Khader SAE, Mai AN, Toan NS, Huy NT, Hanh BTM. Assessing the accuracy of the International Academy of Cytology Yokohama System for reporting breast fine needle aspiration biopsy cytology at a Vietnamese oncology centre. Cytopathology 2023; 34:325-333. [PMID: 36988122 DOI: 10.1111/cyt.13231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 02/16/2023] [Accepted: 03/06/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Fine needle aspiration biopsy (FNAB), accompanied by classification systems for cytology, can offer a cheap and convenient option for the diagnosis of breast cancer in women with suspicious breast lumps. In this study, we aimed to assess the accuracy of the International Academy of Cytology (IAC) Yokohama system in a Vietnamese oncology centre. METHODS A retrospective cross-sectional study was conducted from November 2021 to April 2022 at Vietnam National Cancer Hospital. We included patients with full hospital records regarding breast lesions for which FNAB was indicated. A total of 803 patients' FNAB specimens were assessed according to the IAC Yokohama system. The basic characteristics were summarised using the appropriate summary measurements. The risk of malignancy (ROM) was calculated for each classification category. RESULTS The median age was 42.7 years (range: 14-85). The mean size of the lesions was 17.9 mm (range: 4-123 mm). We had 215 histopathological reports. The most common benign and malignant diagnoses were fibroadenoma and invasive carcinoma, respectively. The ROM for categories II, III, IV, and V was calculated as 3.4%, 37.5%, 95%, and 99.2% respectively. The sensitivity, specificity, positive predictive value, and negative predictive value were 96.4%, 97.2%, 98.5%, and 93.2%, respectively. CONCLUSION The IAC Yokohama system offers a good option with which to predict underlying breast pathology using a simple and cheap procedure. However, pathologists require continuous training to ensure accurate interpretation of the slides.
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Affiliation(s)
- Nguyen Thi Tam
- Department of Pathology, Hanoi Medical University, Hanoi, Vietnam
- Department of Pathology, Hospital 199, Da Nang, Vietnam
| | - Abdelrahman M Makram
- School of Public Health, Imperial College London, London, UK
- Online Research Club (http://www.onlineresearchclub.org), Nagasaki, Japan
| | - Randa Elsheikh
- Online Research Club (http://www.onlineresearchclub.org), Nagasaki, Japan
- Deanery of Biomedical Sciences at Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
- Faculty of Medicine, October 6 University, Giza, Egypt
| | - Sarah Abd Elaziz Khader
- Online Research Club (http://www.onlineresearchclub.org), Nagasaki, Japan
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Anh Nam Mai
- Online Research Club (http://www.onlineresearchclub.org), Nagasaki, Japan
- Faculty of Medicine, College of Medicine and Pharmacy, Duy Tan University, Da Nang, Vietnam
- Institute for Research and Training in Medicine, Biology and Pharmacy, Duy Tan University, Da Nang, Vietnam
| | - Nguyen-Sy Toan
- Faculty of Chemical Technology and Environment, University of Technology and Education, The University of Da Nang, Da Nang, Vietnam
| | - Nguyen Tien Huy
- Online Research Club (http://www.onlineresearchclub.org), Nagasaki, Japan
- School of Global Humanities and Social Sciences, Nagasaki University, Nagasaki, Japan
| | - Bui Thi My Hanh
- Department of Pathology, Hanoi Medical University, Hanoi, Vietnam
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Odate T, Le MK, Kawai M, Kubota M, Yamaguchi Y, Kondo T. Tumor-infiltrating lymphocytes in breast FNA biopsy cytology: a predictor of tumor-infiltrating lymphocytes in histologic evaluation. Cancer Cytopathol 2022; 130:336-343. [PMID: 35129867 DOI: 10.1002/cncy.22551] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Tumor-infiltrating lymphocytes (TILs) are associated with various clinicopathological features. Using cytologic specimens for assessing TILs remains to be established. This retrospective study aimed to establish a practical method to assess TILs in cytologic samples. METHODS The authors found 1101 breast fine-needle aspiration biopsy (FNAB) cytology samples in their hospital, and 214 of them met the inclusion criteria. The TILs score was evaluated using histologic slides, and breast cancers were divided into 2 groups: low- (<60%) and high-TILs (≥60%). Training and validation tests composed of 50 breast cancer samples each were constructed. A cytologic TILs (cTILs) score was introduced to evaluate lymphocytes in FNAB cytology and it was compared with histologically evaluated TILs. The cTILs score was calculated by subtracting the number of neutrophils from the number of lymphocytes surrounding the tumor cells. RESULTS In the training test, a 2-tier system with low- and high-TILs groups showed a large area under the curve (AUC) (0.943; 95% confidence interval [CI], 0.84-0.99). A cTILs score cutoff value of >8 had 87.5% sensitivity and 90.5% specificity. In the validation test, the AUC was 0.79 (95% CI, 0.6-0.93) whereas sensitivity and specificity were 57% and 89.5%, respectively. When small tumors <0.5 cm were excluded, the AUC improved to 0.93 (95% CI, 0.83-1.0), and sensitivity and specificity were 80% and 88.5%, respectively. CONCLUSIONS The cTILs scoring system had acceptable reproducibility and concordance with TILs on histologic samples for tumors ≥0.5 cm. Cytologic evaluation can potentially substitute for histologic evaluation of TILs.
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Affiliation(s)
- Toru Odate
- Department of Pathology, University of Yamanashi, Chuo, Japan
| | - Minh-Khang Le
- Department of Pathology, University of Yamanashi, Chuo, Japan
| | - Masataka Kawai
- Department of Pathology, University of Yamanashi, Chuo, Japan
| | - Mizuki Kubota
- Department of Pathology, University of Yamanashi, Chuo, Japan
| | - Yohei Yamaguchi
- Department of Pathology, University of Yamanashi, Chuo, Japan
| | - Tetsuo Kondo
- Department of Pathology, University of Yamanashi, Chuo, Japan
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Yadav K, Cree I, Field A, Vielh P, Mehrotra R. Importance of Cytopathologic Diagnosis in Early Cancer Diagnosis in Resource-Constrained Countries. JCO Glob Oncol 2022; 8:e2100337. [PMID: 35213215 PMCID: PMC8887942 DOI: 10.1200/go.21.00337] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/22/2021] [Accepted: 01/13/2022] [Indexed: 12/15/2022] Open
Abstract
PURPOSE The rising cancer burden in low- and middle-income countries (LMICs) stresses already weak health care systems and poses unique challenges. In resource-constrained LMICs and in circumstances where most patients must pay out of pocket for diagnostic tests, these may not be available or affordable for many. Cytopathology provides a simple, inexpensive, standardized, and low-technology diagnostic procedure that is increasingly used as an effective tool to address the hurdles faced in cancer control programs in LMICs. This review explores the potential role of cytopathology in LMICs in reducing the cancer burden. METHODS This review studied the existing literature across the globe regarding the utilization of cytopathology as a diagnostic or screening tool for various types of malignancies as well as its advantages and disadvantages, depending on the local situation. RESULTS Apart from the usefulness of cytopathology, this review also sheds light on the barriers to using cytopathology in LMICs. Most recently, SARS-CoV-2 has produced several unique challenges for cytopathology. These are being met with innovative measures to combat the effects of the pandemic and ensure the safe delivery of essential cytopathology services. CONCLUSION The usefulness of cytopathologic techniques has been demonstrated via various studies, even during the recent pandemic. If cytology is to be used appropriately, the focus needs to be on integrating it into the national cancer screening and diagnostic programs as well as providing well-trained human resources.
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Affiliation(s)
- Kavita Yadav
- Centre of Social Medicine & Community Health, JNU, New Delhi, India
| | - Ian Cree
- WHO Classification of Tumours, International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France
| | - Andrew Field
- Department of Anatomical Pathology, University of NSW and Notre Dame University Medical Schools, St Vincent's Hospital, Sydney, New South Wales, Australia
| | | | - Ravi Mehrotra
- Chip Foundation, Noida, India
- Rollins School of Public Health, Emory University, Atlanta, GA
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Saito R, Ikeda I, Izumi K, Tsumura R, Iwata H. Robotic Cytology using Extra-Fine Needles : -Proposal of Puncture Control Strategy for Increasing Collection Amount. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:1452-1456. [PMID: 34891559 DOI: 10.1109/embc46164.2021.9629674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Fine needle aspiration cytology requires accurate needle insertion into a tumor and sufficient amount collection of samples, which highly depends on the skill of the physician. The advantage of the diagnosis is to minimize the tissue damage with the fine needle, while, when the amount of the sample sucked from the lesion is not enough for the definite diagnosis, the procedure has to be repeated until satisfying them. Although numerous research reported a robot-assisted insertion method to improve the accuracy of needle placement with fine needles, there was less research to address the efficient tissue collection. Ideally, the amount of the samples can be satisfied for the diagnosis even if an extra-fine needle (e.g. 25-gauge) is used. This paper proposes a novel needle insertion method for increasing the amount of the tissue sample with the extra-fine needle. The proposed insertion method comprises the round-trip insertion motion and trajectory rerouting with the nature of the bevel-tipped needle. The phantom study's result showed the equivalency of the aspiration amount between a physician's manual procedure with a 22-gauge needle and the proposed method with a 25-gauge needle (4.5 ± 1.0 mg vs 5.1 ± 0.7 mg). The results suggested that the proposed robotic aspiration method can increase the sampling amount with the extra-fine needle in the fine needle aspiration cytology.
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Agrawal N, Kothari K, Tummidi S, Sood P, Agnihotri M, Shah V. Fine-Needle Aspiration Biopsy Cytopathology of Breast Lesions Using the International Academy of Cytology Yokohama System and Rapid On-Site Evaluation: A Single-Institute Experience. Acta Cytol 2021; 65:463-477. [PMID: 34515039 DOI: 10.1159/000518375] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 07/07/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Breast cancer is rapidly emerging as the leading cause of cancer in Indian women. Robust cytopathology and histopathology services are required to tackle this growing burden. The use of rapid on-site evaluation (ROSE) and the International Academy of Cytology (IAC) Yokohama System for Reporting Breast Fine-Needle Aspiration Biopsy (FNAB) Cytopathology, which offers structured protocols, are expected to improve breast cytopathology reporting. METHODS We retrieved the cytopathology slides, categorized them by the IAC Yokohama System and histopathology data of all the patients who had been investigated for breast lesions from September 2016 to December 2018, and compared the cytopathology and histopathology. Risk of malignancy (ROM) and performance metrics, like sensitivity, specificity, predictive values, accuracy, and area under the curve were computed. RESULTS A total of 1,147 FNABs were evaluated, of which 442 (38.5%) underwent ROSE and 624 (54.4%) histopathology. Reported using IAC categories, our cohort recorded 4.9% inadequate, 65.3% benign, 7.8% atypical, 3.3% suspicious for malignancy, and 18.7% malignant lesions. The overall sensitivity and specificity for identifying in situ and malignant lesions were 99.1% and 99.3%, respectively, and were substantially improved by ROSE. ROSE improved the concordance between cytopathology and histopathology from 76.9% to 90.2%, by reducing inadequate (p < 0.001) cases. The ROM increased along a gradient from inadequate to malignant categories, with the gradient being sharpened by ROSE. The false negativity rate was 0.7% and false positivity rate 0%. CONCLUSION Incorporating ROSE and the IAC Yokohama System for breast cytopathology reporting improves accurate diagnosis of breast lesions, prevents missed diagnoses, and provides reliable estimates of ROM. These protocols also aid in standardizing a reproducible system for monitoring and auditing of breast pathology services, identify areas that need strengthening, and improve training at pathology centers.
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Affiliation(s)
- Neha Agrawal
- Department of Cytopathology, Seth GSMC & KEMH, Parel, Mumbai, India
| | - Kanchan Kothari
- Department of Cytopathology, Seth GSMC & KEMH, Parel, Mumbai, India
| | - Santosh Tummidi
- Department of Pathology, All India Institute of Medical Sciences (AIIMS), Mangalagiri, India
| | - Prashant Sood
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Bilaspur, India
| | - Mona Agnihotri
- Department of Cytopathology, Seth GSMC & KEMH, Parel, Mumbai, India
| | - Vyoma Shah
- Sir HN Reliance Foundation Hospital, Mumbai, India
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7
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Dixit N, Trivedi S, Bansal VK. A retrospective analysis of 512 cases of breast fine needle aspiration cytology utilizing the recently proposed IAC Yokohama system for reporting breast cytopathology. Diagn Cytopathol 2021; 49:1022-1031. [PMID: 34133084 DOI: 10.1002/dc.24808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 04/14/2021] [Accepted: 05/19/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Recently the International Academy of Cytology (IAC) introduced a new reporting system for breast fine-needle aspiration cytology that classifies cytologic diagnoses into five-categories: (I) insufficient material, (II) benign, (III) atypical, (IV) suspicious of malignancy, and (V) malignant. The current study was undertaken to categorize the breast lesions utilizing the newly proposed IAC Yokohama classification system and evaluate the risk of malignancy (ROM) for respective categories and the diagnostic yield of this technique. METHODS All FNAs of breast lesions over 2.5 years were categorized retrospectively using the newly proposed IAC Yokohama reporting system. The ROM was calculated along with sensitivity, specificity, positive and negative predictive value, diagnostic accuracy, false positive, and false-negative rate using the histological diagnosis as the gold standard. RESULTS The 512 cases were distributed as follows: Category I (insufficient material) 7.4%, Category II (benign) 74%, Category III (atypical) 5.7%, Category IV(suspicious) 1.4%, and Category V (malignant) 11.5%. Histopathological correlation was available in 285 (55.7%) cases. The respective ROM calculated was 33.3%, 0.5%, 13.3%, 83.3%, and 100% for Category I-V. The Sensitivity, Specificity, Positive and Negative Predictive Value, and Diagnostic accuracy were 95%, 99.5%, 98.27%, 98.6, and 98.5% respectively. CONCLUSIONS Despite previous attempts to establish a standardized diagnostic terminology, there has been a lack of a single internationally approved standardized reporting system allowing substantial diagnostic clarity and incorporating distinct diagnostic categories, each linked with a specific ROM and recommended management. This System also provides enhanced communication between pathologists and attending clinicians for the benefit of the patient.
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Affiliation(s)
- Nutan Dixit
- Department of Pathology, Indira Gandhi ESI Hospital, Delhi, India
| | - Shalini Trivedi
- Department of Pathology, Indira Gandhi ESI Hospital, Delhi, India
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Marabi M, Aphivatanasiri C, Jamidi SK, Wang C, Li JJ, Hung EH, Poon IK, Tsang JY, Tse GM. The International Academy of Cytology Yokohama System for Reporting Breast Cytopathology showed improved diagnostic accuracy. Cancer Cytopathol 2021; 129:852-864. [PMID: 34029453 DOI: 10.1002/cncy.22451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/21/2021] [Accepted: 02/24/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND The aim of the International Academy of Cytology Yokohama System for Reporting Breast Fine Needle Aspiration Biopsy Cytopathology is to improve cytology practice. This study assessed cytologic diagnoses made with the system and its efficacy when it was applied by pathologists with different levels of experience. METHODS In all, 1080 cases of breast fine-needle aspiration biopsy (FNAB) over a period of 16 years were reviewed and reclassified with the system. The category distribution and the diagnostic performance were compared with the original diagnoses. The concordance rates for diagnoses from pathologists with different levels of experience were also determined. RESULTS The distribution of cytologic diagnoses made with the system was as follows: 11.7% were insufficient, 56.6% were benign, 20.1% were atypical, 6.1% were suspicious for malignancy, and 5.6% were malignant. The rates for the insufficient and atypical categories were lower than the original diagnosis rates (13.1% and 23.8%, respectively). Overall, 120 cases (11.1%) were recategorized. Among those recategorized as benign, suspicious, or malignant with follow-up data, 96.7% were correctly reclassified. A significant improvement in diagnostic performance was found with the system (P < .001). Such improvement was also seen in problematic breast lesions, including fibroepithelial lesions, papillary lesions, and low-grade carcinomas. Pathologists with intermediate experience showed a higher concordance with an expert pathologist in the diagnoses than those with short experience (κ, 0.838 vs 0.634). CONCLUSIONS The system effectively categorized the diagnoses, and the diagnostic performance of FNAB reporting was improved. The structured reporting also enhanced the reproducibility of reporting by pathologists with intermediate experience and, to some extent, those with short experience.
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Affiliation(s)
- Monalyn Marabi
- Department of Pathology, Faculty of Medicine and Surgery, University of Santo Tomas, Manila, Philippines
| | | | | | - Chao Wang
- Department of Pathology, Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Joshua J Li
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Esther H Hung
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Ivan K Poon
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Julia Y Tsang
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Gary M Tse
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
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Field AS, Raymond WA, Schmitt F. The International Academy of Cytology Yokohama System for Reporting Breast Fine Needle Aspiration Biopsy Cytopathology: Recent research findings and the future. Cancer Cytopathol 2021; 129:847-851. [PMID: 34029451 DOI: 10.1002/cncy.22450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 04/16/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Andrew S Field
- St Vincent's Hospital Medical School, University of New South Wales, Sydney, New South Wales, Australia.,Medical School, Notre Dame University, Sydney, New South Wales, Australia.,Department of Anatomical Pathology, St. Vincent's Hospital, Sydney, New South Wales, Australia
| | - Wendy A Raymond
- Department of Surgical Pathology, Flinders Medical Centre/Flinders University, Adelaide, South Australia, Australia.,Clinpath Laboratories, Adelaide, South Australia, Australia
| | - Fernando Schmitt
- Medical Faculty of Porto University, Porto, Portugal.,Institute of Molecular Pathology and Immunology of Porto University, Porto, Portugal.,Health Research Network, Porto, Portugal
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10
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Tejeswini V, Chaitra B, Renuka IV, Laxmi K, Ramya P, Sowjanya KKS. Effectuation of International Academy of Cytology Yokahama Reporting System of Breast Cytology to Assess Malignancy Risk and Accuracy. J Cytol 2021; 38:69-73. [PMID: 34321772 PMCID: PMC8280858 DOI: 10.4103/joc.joc_20_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 06/16/2020] [Accepted: 04/13/2021] [Indexed: 01/17/2023] Open
Abstract
Introduction Recently the International Academy of Cytology (IAC) proposed a new Yokahama reporting system for breast fine-needle aspiration cytology (2019) in order to standardize reporting pattern and to link cytology reporting to management algorithms. Aims and Objectives To categorize the samples according to the newly proposed IAC Yokahama reporting system of breast cytology and to assess diagnostic accuracy and corresponding risk of malignancy (ROM) for each category. Materials and Methods This is a retrospective study of breast cytology cases done at Department of Pathology. The slides are retrieved from pathology archives and classified using a recently proposed IAC, Yokahama reporting system of breast cytology into five categories. The risk of malignancy, sensitivity, specificity, and diagnostic accuracy were estimated on the basis of the final histopathological diagnosis. Results Of the 386 cases of breast FNAC, 226 (55.55%) had the corresponding histological diagnosis. The respective ROM for each category was 22.22% for category 1 (insufficient material), 5.32% for category 2 (benign), 26.31% for category 3 (atypical), 100% for category 4 (suspicious for malignancy), and 100 % category 5 (malignant). Malignant cases were considered only when positive tests, the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were 89.66%, 100%, 100%, 90.2%, and 94.69%, respectively. Conclusions The present study showed statistically significant sensitivity, specificity, and diagnostic accuracy, especially with malignant cases. Hence, using the IAC Yokahama reporting system of breast cytology is effective to standardize the reporting in various institutes and provide clear guidelines to clinician for further management.
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Affiliation(s)
- Vaddatti Tejeswini
- Department of Pathology, NRI Medical College, Chinakakani, Mangalagiri, Guntur, Andhra Pradesh, India
| | - B Chaitra
- Department of Pathology, NRI Medical College, Chinakakani, Mangalagiri, Guntur, Andhra Pradesh, India
| | - I V Renuka
- Department of Pathology, NRI Medical College, Chinakakani, Mangalagiri, Guntur, Andhra Pradesh, India
| | - Kasula Laxmi
- Department of Pathology, NRI Medical College, Chinakakani, Mangalagiri, Guntur, Andhra Pradesh, India
| | - Potti Ramya
- Department of Pathology, NRI Medical College, Chinakakani, Mangalagiri, Guntur, Andhra Pradesh, India
| | - K K S Sowjanya
- Department of Pathology, NRI Medical College, Chinakakani, Mangalagiri, Guntur, Andhra Pradesh, India
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11
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Field AS, Kurtycz DFI, Raymond WA, Schmitt F. The International Academy of Cytology Yokohama System for Reporting Breast Fine Needle Aspiration Biopsy Cytopathology: Analysis and discussion of the response to a web-based survey. Cancer Cytopathol 2020; 129:450-459. [PMID: 33369266 DOI: 10.1002/cncy.22397] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 10/24/2020] [Accepted: 11/16/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND A group of international experts in breast fine needle aspiration biopsy (FNAB) cytopathology, supported by the International Academy of Cytology (IAC), drafted a comprehensive system for reporting breast FNAB cytopathology in 2017-2018. The editorial team produced a survey to assess the international response to the proposed category structure, definitions, and management recommendations in this draft. METHODS A web-based survey of 186 questions was generated using the Qualtrics software package (Provo, Utah) supported by the Division of Information Technology at the University of Wisconsin-Madison. The survey was advertised widely-including through the IAC, American Society of Cytopathology, Japanese Society of Clinical Cytology, Papanicolaou Society of Cytopathology, and Australian Society of Cytology and to audiences at national and international meetings-and was available from April to June 2018. The data obtained from the 265 respondents was assessed by the editorial team. RESULTS The survey provided a snapshot of the current role and use of breast FNAB and the international variations. Demographic questions were followed by specific questions based on the draft category definitions and statements and focused on issues that had generated discussion among the authors, including the FNAB diagnosis of ductal carcinoma in situ. CONCLUSION The survey results strongly supported the development of the IAC Yokohama System and informed subsequent discussions among the authors regarding the final text.
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Affiliation(s)
- Andrew S Field
- Medical Schools, University of New South Wales and Notre Dame University Medical Schools, Sydney, New South Wales, Australia.,Department of Anatomical Pathology, St. Vincent's Hospital, Sydney, New South Wales, Australia
| | - Daniel F I Kurtycz
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin.,Wisconsin State Laboratory of Hygiene, University of Wisconsin-Madison, Madison, Wisconsin
| | - Wendy A Raymond
- Department of Surgical Pathology, Flinders Medical Centre and Flinders University of South Australia, Adelaide, South Australia, Australia.,Clinpath Laboratories, Adelaide, South Australia, Australia
| | - Fernando Schmitt
- Institute of Molecular Pathology and Immunology of Porto University, Instituto de Investigação e Inovação em Saúde and Medical Faculty, University of Porto, Porto, Portugal
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Oosthuizen M, Razack R, Edge J, Schubert PT. Classification of Male Breast Lesions According to the IAC Yokohama System for Reporting Breast Cytopathology. Acta Cytol 2020; 65:132-139. [PMID: 33333512 DOI: 10.1159/000512041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/05/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study aims to determine the diagnostic utility of the International Academy of Cytology (IAC) Yokohama System for reporting breast cytopathology in lesions of the male breast. STUDY DESIGN Fine-needle aspiration biopsy (FNAB) reports between 2015 and 2019 were retrospectively recategorized according to the 5-tiered IAC Yokohama Reporting System. Our database yielded a total of 1,532 FNAB reports from breast lesions, obtained from 1,350 male patients. The risk of malignancy (ROM) and diagnostic performance of FNAB were determined using follow-up histopathological diagnosis and/or clinical follow-up, where available, for each category. RESULTS The category distribution were as follows: inadequate, 40%; benign, 57%; atypical, 0.6%; suspicious for malignancy, 0.7%; and malignant, 1.6%. The ROM in each category was nondiagnostic, 11%; benign, 3%; atypical, 28%; suspicious for malignancy, 56%; and malignant, 100%. The sensitivity, specificity, positive predictive value, and negative predictive value were recorded as 63, 100, 100, and 84.6% respectively, when only malignant cases were considered as positive tests. CONCLUSION This study validates the IAC Yokohama System for reporting male breast cytopathology. In accordance with the aim of the Yokohama System to establish best practice guidelines for reporting breast cytopathology, this comprehensive scheme facilitates comparisons between local and international institutions. The ROM acts as an internal audit for quality assurance within one's own laboratory and provides guidance for clinical management. It highlights inefficiencies such as high inadequacy rates for category 1 and also features strengths with impressive specificity for categories 4 and 5.
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Affiliation(s)
- Melissa Oosthuizen
- Division of Anatomical Pathology, National Health Laboratory Service, Tygerberg Hospital, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa,
| | - Rubina Razack
- Division of Anatomical Pathology, National Health Laboratory Service, Tygerberg Hospital, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jenny Edge
- Breast and Endocrine Unit, Division of General Surgery, Tygerberg Hospital, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Pawel Tomasz Schubert
- Division of Anatomical Pathology, National Health Laboratory Service, Tygerberg Hospital, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Saieg M, Lozano MD, Perez-Machado M. The role of cytopathology practice and research in the development of personalized medicine in Iberoamerica. Diagn Cytopathol 2020; 48:819-820. [PMID: 32485070 DOI: 10.1002/dc.24509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/14/2020] [Accepted: 05/15/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Mauro Saieg
- Department of Pathology, Santa Casa Medical School, São Paulo, Brazil.,Department of Pathology, A C Camargo Cancer Center, São Paulo, Brazil
| | - Maria D Lozano
- Department of Pathology, Clínica University of Navarra, Pamplona, Spain
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Field AS, Raymond WA, Rickard M, Schmitt F. Breast fine needle aspiration biopsy cytology: the potential impact of the International Academy of Cytology Yokohama System for Reporting Breast Fine Needle Aspiration Biopsy Cytopathology and the use of rapid on-site evaluation. J Am Soc Cytopathol 2020; 9:103-111. [PMID: 32044283 DOI: 10.1016/j.jasc.2019.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/26/2019] [Accepted: 10/28/2019] [Indexed: 12/19/2022]
Abstract
The present report reviews the current problems associated with the routine use of breast fine needle aspiration biopsy (FNAB) and discusses the potential impact that the new International Academy of Cytology (IAC) Yokohama Reporting System and the use of rapid on-site evaluation (ROSE) should have on reducing these problems to optimize breast care for patients. The recently reported IAC System aims to establish the best practice guidelines for breast FNAB, emphasizing the importance of the FNAB technique and the skillful preparation of direct smears. The IAC System proposes a standardized report and established clear terminology for defined reporting categories, each of which has a risk of malignancy and is linked to management options. The FNAB techniques that will optimize the biopsy specimen and reduce poor quality smears are reviewed and the benefits of ROSE are discussed. FNAB can diagnose accurately the vast majority of breast lesions, and ROSE has been recommended whenever possible to reduce the rate of insufficient/inadequate cases and increase the number of specific benign and malignant diagnoses. ROSE performed by a cytopathologist provides a provisional diagnosis, reducing patient anxiety and facilitating management through cost-effective immediate triage and patient selection for ancillary testing. Thus, patients can be selected for immediate core needle biopsy, as required.
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Affiliation(s)
- Andrew S Field
- University of New South Wales Medical School, Notre Dame University Medical School, and Department of Anatomical Pathology, St. Vincent's Hospital, Sydney, Australia.
| | - Wendy A Raymond
- Department of Surgical Pathology, Flinders Medical Centre and Flinders University of South Australia, and Clinpath Laboratories, Adelaide, Australia
| | - Mary Rickard
- BreastScreen NSW and Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Fernando Schmitt
- Institute of Molecular Pathology and Immunology of Porto University, Instituto de Investigação e Inovação em Saúde and Medical Faculty of University of Porto, Porto, Portugal
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Field AS, Raymond WA, Rickard M, Arnold L, Brachtel EF, Chaiwun B, Chen L, Di Bonito L, Kurtycz DFI, Lee AHS, Lim E, Ljung BM, Michelow P, Osamura RY, Pinamonti M, Sauer T, Segara D, Tse G, Vielh P, Chong PY, Schmitt F. The International Academy of Cytology Yokohama System for Reporting Breast Fine-Needle Aspiration Biopsy Cytopathology. Acta Cytol 2019; 63:257-273. [PMID: 31112942 DOI: 10.1159/000499509] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 03/07/2019] [Indexed: 01/29/2023]
Abstract
The International Academy of Cytology (IAC) gathered together a group of cytopathologists expert in breast cytology who, working with clinicians expert in breast diagnostics and management, have developed the IAC Yokohama System for Reporting Breast Fine-Needle Aspiration Biopsy (FNAB) Cytology. The project was initiated with the first cytopathology group meeting in Yokohama at the 2016 International Congress of Cytology. This IAC Yokohama System defines five categories for reporting breast cytology, each with a clear descriptive term for the category, a definition, a risk of malignancy (ROM) and a suggested management algorithm. The key diagnostic cytopathology features of each of the lesions within each category will be presented more fully in a subsequent atlas. The System emphasizes that the crucial requirements for diagnostic breast FNAB cytology are a high standard for the performance of the FNAB and for the making of direct smears, and well-trained experienced cytopathologists to interpret the material. The performance indicators of breast FNAB, including specificity and sensitivity, negative predictive value, positive predictive value and ROM stated in this article have been derived from the recent literature. The current practice of breast FNAB has evolved with the increasing use of ultrasound guidance and rapid on-site evaluation. Two recent publications have shown a range of ROM for the insufficient/inadequate category of 2.6-4.8%, benign 1.4-2.3%, atypical 13-15.7%, suspicious of malignancy 84.6-97.1%, and malignant 99.0-100%. The management algorithm in the System provides options because there are variations in the management of breast lesions using FNAB and core-needle biopsy in those countries utilizing the "triple test" of clinical, imaging, and FNAB assessment, and also variations in the availability of CNB and imaging in low- and middle-income countries. The System will stimulate further discussion and research, particularly in the cytological diagnostic features of specific lesions within each category and in management recommendations. This will lead to continuing improvements in the care of patients with breast lesions and possible modifications to the IAC Yokohama System.
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Affiliation(s)
- Andrew S Field
- Department of Pathology, St Vincent's Hospital, and University of NSW and University of Notre Dame Medical Schools, Sydney, New South Wales, Australia,
| | - Wendy A Raymond
- South Australian Pathology, Department of Surgical Pathology, Flinders Medical Centre, Flinders University of South Australia, and Clinpath, Adelaide, South Australia, Australia
| | - Mary Rickard
- BreastScreen NSW and Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Lauren Arnold
- Sydney Breast Clinic, Sydney, New South Wales, Australia
| | - Elena F Brachtel
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Benjaporn Chaiwun
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Lan Chen
- Pathology Department, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Luigi Di Bonito
- Department of Anatomical Pathology, University of Trieste, Trieste, Italy
| | - Daniel F I Kurtycz
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Wisconsin State Laboratory of Hygiene, University of Wisconsin, Madison, Wisconsin, USA
| | - Andrew H S Lee
- Department of Histopathology, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Elgene Lim
- Connie Johnson Breast Cancer Research Laboratory, Garvan Institute of Medical Research, St Vincent's Hospital, UNSW Medical School, Sydney, New South Wales, Australia
| | - Britt-Marie Ljung
- Department of Pathology, University of California San Francisco, San Francisco, California, USA
| | - Pamela Michelow
- Department of Anatomical Pathology, University of the Witwatersrand, Johannesburg, South Africa
- National Health Laboratory Service, Johannesburg, South Africa
| | - Robert Y Osamura
- Nippon Koukan Hospital, Kawasaki, Japan
- Keio University School of Medicine, Tokyo, Japan
| | | | - Torill Sauer
- Institute of Clinical Medicine, Department of Pathology, Faculty of Medicine, Akershus University Hospital, University of Oslo, Oslo, Norway
| | - Davendra Segara
- Breast Surgical Oncologist, St Vincent's Private Hospital, Sydney, New South Wales, Australia
| | - Gary Tse
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, Sha Tin, Hong Kong
| | - Philippe Vielh
- Laboratoire National de Santé, Departement de Pathologie Morphologique et Moleculaire, Dudelange, Luxembourg
| | - Phek Y Chong
- Department of Pathology, Sengkang General Hospital, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore
| | - Fernando Schmitt
- Institute of Molecular Pathology and Immunology, Instituto de Investigação e Inovação em Saúde and Medical Faculty, University of Porto, Porto, Portugal
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Wong S, Rickard M, Earls P, Arnold L, Bako B, Field AS. The International Academy of Cytology Yokohama System for Reporting Breast Fine Needle Aspiration Biopsy Cytopathology: A Single Institutional Retrospective Study of the Application of the System Categories and the Impact of Rapid Onsite Evaluation. Acta Cytol 2019; 63:280-291. [PMID: 31108486 DOI: 10.1159/000500191] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 04/04/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To review the performance and utility of the International Academy of Cytology (IAC) Yokohama System for Reporting Breast Fine Needle Aspiration Biopsy (FNAB) Cytology five category stratification and evaluate the impact of rapid onsite evaluation (ROSE). METHOD A retrospective analysis of breast FNAB cytology cases with matched histopathological results at a single institution over a 32 months period using a structured reporting system with 5 diagnostic categories ("inadequate/insufficient," "benign," "atypical," "suspicious of malignancy" and "malignant") closely paralleling the proposed IAC System. RESULTS Of 2,696 breast FNAB cases, there were 579 with matched histopathology and 456 of these had ROSE. ROSE decreased the number in the "insufficient" category (17.1% without ROSE to 4.0% with ROSE) and increased the number in the "malignant" (17.9 to 39.0%) with a lesser impact on the "atypical," "benign" and "suspicious of malignancy" categories. The performance data showed a positive predictive value of 96.4%, negative predictive value of 97.6%, and a risk of malignancy of a FNAB categorized as "insufficient" to be 2.6%, "benign" 1.7%, "atypical" 15.7%, "suspicious of malignancy" 84.6%, and "malignant" 99.5%. CONCLUSION Breast FNAB is an accurate test enabling effective diagnosis of breast lesions. ROSE improved the performance by decreasing the proportion of "insufficient" and "atypical" and increasing the "suspicious of malignancy" and "malignant" diagnoses and enabling immediate triage for further biopsy where necessary.
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Affiliation(s)
- Stephen Wong
- Department of Anatomical Pathology, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
| | - Mary Rickard
- Consultant Radiologist BreastScreen NSW and Faculty of Health Sciences University of Sydney, Sydney, New South Wales, Australia
| | - Peter Earls
- Department of Anatomical Pathology, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
| | - Lauren Arnold
- Sydney Breast Clinic, Sydney, New South Wales, Australia
| | | | - Andrew S Field
- University of NSW and Notre Dame University Medical Schools and Department of Anatomical Pathology, St Vincent's Hospital, Sydney, New South Wales, Australia,
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McHugh KE, Bird P, Sturgis CD. Concordance of breast fine needle aspiration cytology interpretation with subsequent surgical pathology: An 18‐year review from a single sub‐Saharan African institution. Cytopathology 2019; 30:519-525. [DOI: 10.1111/cyt.12696] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/22/2019] [Accepted: 03/24/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Kelsey E. McHugh
- Department of Laboratory Medicine Cleveland Clinic Cleveland OH USA
| | - Peter Bird
- Department of Surgery AIC Kijabe Hospital Kijabe Kenya
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Montezuma D, Malheiros D, Schmitt FC. Breast Fine Needle Aspiration Biopsy Cytology Using the Newly Proposed IAC Yokohama System for Reporting Breast Cytopathology: The Experience of a Single Institution. Acta Cytol 2019; 63:1-6. [PMID: 30783035 DOI: 10.1159/000492638] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 07/18/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Recently the International Academy of Cytology (IAC) proposed a new reporting system for breast fine needle aspiration biopsy (FNAB) cytology. We aimed to categorize our samples according to this classification and to assess the risk of malignancy (ROM) for each category as well as the diagnostic yield of breast FNAB. STUDY DESIGN Breast FNAB specimens obtained between January 2007 and December 2017 were reclassified according to the newly proposed IAC Yokohama reporting system. The ROM for each category was determined. Diagnostic yield was evaluated based on a three-category approach, benign versus malignant. RESULTS The samples were distributed as follows: insufficient material 5.77%, benign 73.38%, atypical 13.74%, suspicious for malignancy 1.57%, and malignant 5.54%. Of the 3,625 cases collected, 776 (21.4%) had corresponding histology. The respective ROM for each category was 4.8% for category 1 (insufficient material), 1.4% for category 2 (benign), 13% for category 3 (atypical), 97.1% for category 4 (suspicious for malignancy), and 100% for category 5 (malignant). When only malignant cases were considered positive tests, the sensitivity, specificity, and diagnostic accuracy were 97.56, 100, and 99.11%, respectively. CONCLUSIONS Our study is the first to categorize breast FNAB cytology samples according to the proposed IAC reporting system and to evaluate patient outcomes based on this categorization.
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Affiliation(s)
- Diana Montezuma
- Portuguese Institute of Oncology, Porto, Portugal
- Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal
| | - Daniela Malheiros
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
- Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal
| | - Fernando C Schmitt
- Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal,
- Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal,
- Medical Faculty, University of Porto, Porto, Portugal,
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Chauhan V, Pujani M, Agarwal C, Chandoke RK, Raychaudhuri S, Singh K, Sharma N, Khandelwal A, Agarwal A. IAC standardized reporting of breast fine-needle aspiration cytology, Yokohama 2016: A critical appraisal over a 2 year period. Breast Dis 2019; 38:109-115. [PMID: 31524134 DOI: 10.3233/bd-190393] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Breast cytology is a significant component of the "Triple approach" for pre-operative diagnosis of breast lumps, the other two being clinical assessment and radiological imaging. The role of Fine needle aspiration cytology (FNAC) as a first line investigation in diagnosing breast lesions is well documented, however histopathology is the gold standard. Cyto-histopathological correlation is of great relevance and also increases precision.AIMS \& OBJECTIVES:The present study was conducted with the aim to categorize breast lesions according to the latest standardized reporting system proposed by International academy of cytologists (IAC) in 2016. Evaluation of diagnostic accuracy, sensitivity and specificity of FNAC in diagnosing breast lesions and cyto-histopathological correlation was planned. MATERIALS AND METHODS All FNAs of breast lesions over a period of 2 years were included in the study. The cases were grouped into five standardized categories proposed by the International academy of cytology: Category I (Insufficient material), Category II (Benign), Category III (Atypical, probably benign), Category IV (Suspicious, probably in situ or invasive) & Category V (Malignant) respectively. Specificity, sensitivity, diagnostic accuracy, negative and positive predictive value of FNAC were calculated and cyto-histopathological correlation assessed wherever possible. RESULTS Out of 468 breast lesions reported on FNAC, the category wise distribution was - Category I, II, III, IV & V accounting for 23(4.9%), 342(73.07%), 7(1.5%), 11(2.35%) and 85(18.16%) respectively. Histopathology was performed in 331/468 cases with cyto histological concordance of 98.4% and a type agreement rate of 90.9%. The sensitivity, specificity, positive and negative predictive value and diagnostic accuracy was 98.90%, 99.16%, 97.82%, 99.58% and 99.09% respectively. CONCLUSION FNAC is a simple, reliable, cost effective, first line diagnostic procedure for all breast lumps. In collaboration with physical examination and imaging studies (triple approach), FNAC is a highly sensitive diagnostic tool. Adopting a universally acceptable standardized reporting system for breast cytology can enhance the diagnostic accuracy of FNAC.
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Affiliation(s)
- Varsha Chauhan
- Department of Pathology, ESIC Medical College & Hospital, NIT 3, Faridabad, India
| | - Mukta Pujani
- Department of Pathology, ESIC Medical College & Hospital, NIT 3, Faridabad, India
| | - Charu Agarwal
- Department of Pathology, ESIC Medical College & Hospital, NIT 3, Faridabad, India
| | - R K Chandoke
- Department of Pathology, ESIC Medical College & Hospital, NIT 3, Faridabad, India
| | - Sujata Raychaudhuri
- Department of Pathology, ESIC Medical College & Hospital, NIT 3, Faridabad, India
| | - Kanika Singh
- Department of Pathology, ESIC Medical College & Hospital, NIT 3, Faridabad, India
| | - Nimisha Sharma
- Department of Pathology, ESIC Medical College & Hospital, NIT 3, Faridabad, India
| | - Aparna Khandelwal
- Department of Pathology, ESIC Medical College & Hospital, NIT 3, Faridabad, India
| | - Anu Agarwal
- Department of Pathology, ESIC Medical College & Hospital, NIT 3, Faridabad, India
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Sundling KE, Kurtycz DFI. Standardized terminology systems in cytopathology. Diagn Cytopathol 2018; 47:53-63. [PMID: 30499199 DOI: 10.1002/dc.24103] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 09/26/2018] [Accepted: 10/05/2018] [Indexed: 01/21/2023]
Abstract
There has been increasing pressure for systemization in cytopathology. Lack of uniformity in categorization, variation in opinion based regional practice, and technologic advancement have created an environment disposed toward creation of more consistent evidence-based approaches to diagnostic problems. This review provides an overview of the major standardized terminology systems in cytology, with historical perspectives and commentary on current uses of these systems. These systems now include gynecologic, thyroid, pancreaticobiliary, urinary, salivary gland, and breast cytology. We summarize major classification systems supported by national and international professional organizations, outlining the structure and goals of each system. Specific benefits and potential pitfalls in the implementation of each system are given. Finally, we address potential criticisms of standardized terminology systems and proposed future directions to continue the evolution of standardized terminology to improve clinical practice.
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Affiliation(s)
- Kaitlin E Sundling
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health Wisconsin State Laboratory of Hygiene, Madison, Wisconsin
| | - Daniel F I Kurtycz
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health Wisconsin State Laboratory of Hygiene, Madison, Wisconsin
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Fulciniti F, Yanoh K, Karakitsos P, Watanabe J, Di Lorito A, Margari N, Maeda Y, Kihara M, Norimatsu Y, Kobayashi TK, Hirai Y. The Yokohama system for reporting directly sampled endometrial cytology: The quest to develop a standardized terminology. Diagn Cytopathol 2018; 46:400-412. [DOI: 10.1002/dc.23916] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 01/08/2018] [Accepted: 02/01/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Franco Fulciniti
- Clinical Cytopathology Service; Istituto Cantonale di Patologia; Locarno, CH-6600 Switzerland
| | - Kenji Yanoh
- Departments of Obstetrics and Gynecology; JA Suzuka General Hospital; Mie Japan
| | - Petros Karakitsos
- Department of Cytopathology, National and Kapodistrian University of Athens; University General Hospital “Attikon”; Athens Greece
| | - Jun Watanabe
- Department of Bioscience and Laboratory Medicine; Hirosaki University Graduate School of Health Science; Aomori Japan
| | - Alessia Di Lorito
- Center of Predictive Molecular Medicine, Center for Excellence on Ageing and Translational Medicine (CeSI-MeT); University of Chieti-Pescara; Chieti Italy
| | - Niki Margari
- Department of Cytopathology, National and Kapodistrian University of Athens; University General Hospital “Attikon”; Athens Greece
| | - Yoshinobu Maeda
- Department of Diagnostic Pathology; Toyama Red Cross Hospital; Toyama Japan
| | - Maki Kihara
- Department of Obstetrics and Gynecology; Faculty of Medicine, Tokyo Women's Medical University
| | - Yoshiaki Norimatsu
- Department of Medical Technology, Faculty of Health Sciences; Ehime Prefectural University of Health Sciences; Ehime Japan
| | - Tadao K. Kobayashi
- Cancer Education and Research Center; Osaka University Graduate School of Medicine and Health Science; Osaka Japan
| | - Yasuo Hirai
- Department of Obstetrics and Gynecology; Faculty of Medicine, Dokkyo Medical University; Tochigi Japan
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