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Khorsandi N, Balassanian R, Vohra P. Fine needle aspiration biopsy in low- and middle-income countries. Diagn Cytopathol 2024; 52:426-432. [PMID: 38576060 DOI: 10.1002/dc.25317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 03/12/2024] [Accepted: 03/26/2024] [Indexed: 04/06/2024]
Abstract
Fine needle aspiration biopsy (FNAB) in low- and middle-income countries (LMIC), can provide minimally invasive, cost-effective tissue diagnosis with rapid assessment and specimen triage, which is advantageous in these resource-limited settings. Nevertheless, challenges such as equipment shortages, reagents, and lack of trained personnel exist. This article discusses the effectiveness of FNAB for diagnosis of malignant and inflammatory conditions across various organs, such as lymph nodes, breast, soft tissue, and thyroid and advocates for increased training opportunities and collaboration with academic centers to enhance diagnostic accuracy and access to pathology services.
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Affiliation(s)
- Nikka Khorsandi
- Department of Pathology, University of California, San Francisco, California, USA
| | - Ron Balassanian
- Department of Pathology, University of California, San Francisco, California, USA
| | - Poonam Vohra
- Department of Pathology, University of California, San Francisco, California, USA
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Suciu V, El Chamieh C, Soufan R, Mathieu MC, Balleyguier C, Delaloge S, Balogh Z, Scoazec JY, Chevret S, Vielh P. Real-World Diagnostic Accuracy of the On-Site Cytopathology Advance Report (OSCAR) Procedure Performed in a Multidisciplinary One-Stop Breast Clinic. Cancers (Basel) 2023; 15:4967. [PMID: 37894334 PMCID: PMC10605571 DOI: 10.3390/cancers15204967] [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: 07/09/2023] [Revised: 08/19/2023] [Accepted: 09/24/2023] [Indexed: 10/29/2023] Open
Abstract
Fine-needle aspiration (FNA) cytology has been widely used for the diagnosis of breast cancer lesions with the objective of differentiating benign from malignant masses. However, the occurrence of unsatisfactory samples and false-negative rates remains a matter of concern. Major improvements have been made thanks to the implementation of rapid on-site evaluation (ROSE) in multidisciplinary and integrated medical settings such as one-stop clinics (OSCs). In these settings, clinical and radiological examinations are combined with a morphological study performed by interventional pathologists. The aim of our study was to assess the diagnostic accuracy of the on-site cytopathology advance report (OSCAR) procedure on breast FNA cytologic samples in our breast OSC during the first three years (April 2004 till March 2007) of its implementation. To this goal, we retrospectively analyzed a series of 1820 breast masses (1740 patients) radiologically classified according to the American College of Radiology (ACR) BI-RADS lexicon (67.6% being either BI-RADS 4 or 5), sampled by FNA and immediately diagnosed by cytomorphology. The clinicoradiological, cytomorphological, and histological characteristics of all consecutive patients were retrieved from the hospital computerized medical records prospectively registered in the central information system. Histopathological analysis and ultrasound (US) follow-up (FU) were the reference diagnostic tests of the study design. In brief, we carried out either a histopathological verification or an 18-month US evaluation when a benign cytology was concordant with the components of the triple test. Overall, histology was available for 1138 masses, whereas 491 masses were analyzed at the 18-month US-FU. FNA specimens were morphologically nondiagnostic in 3.1%, false negatives were observed in 1.5%, and there was only one false positive (0.06%). The breast cancer prevalence was 62%. Diagnostic accuracy measures of the OSCAR procedure with their 95% confidence intervals (95% CI) were the following: sensitivity (Se) = 97.4% (96.19-98.31); specificity (Sp) = 94.98% (92.94-96.56); positive predictive value (PPV) = 96.80% (95.48-97.81); negative predictive value (NPV) = 95.91% (94.02-97.33); positive likelihood ratio (LR+) = 19.39 (13.75-27.32); negative predictive ratio (LR-) = 0.03 (0.02-0.04), and; accuracy = 96.45% (95.42-97.31). The respective positive likelihood ratio (LR+) for each of the four categories of cytopathological diagnoses (with their 95% CI) which are malignant, suspicious, benign, and nondiagnostic were 540 (76-3827); 2.69 (1.8-3.96); 0.03 (0.02-0.04); and 0.37 (0.2-0.66), respectively. In conclusion, our study demonstrates that the OSCAR procedure is a highly reliable diagnostic approach and a perfect test to select patients requiring core-needle biopsy (CNB) when performed by interventional cytopathologists in a multidisciplinary and integrated OSC setting. Besides drastically limiting the rate of nondiagnostic specimens and diagnostic turn-around time, OSCAR is an efficient and powerful first-line diagnostic approach for patient-centered care.
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Affiliation(s)
- Voichita Suciu
- Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France
| | - Carolla El Chamieh
- Department of Biostatistics and Medical Information, INSERM UMR1153 ECSTRRA Team, Hôpital Saint Louis, AP-HP, 75010 Paris, France
| | - Ranya Soufan
- Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France
| | | | | | - Suzette Delaloge
- Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France
| | - Zsofia Balogh
- Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France
| | | | - Sylvie Chevret
- Department of Biostatistics and Medical Information, INSERM UMR1153 ECSTRRA Team, Hôpital Saint Louis, AP-HP, 75010 Paris, France
| | - Philippe Vielh
- Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France
- Medipath and American Hospital of Paris, 92200 Paris, France
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Rohra P, Ding C, Yoon EC, Gan Q. A pilot study: Comparison of TRPS1 and GATA3 immunoperoxidase staining using cytologic smears in entities reportedly positive for GATA3. Cancer Cytopathol 2022; 130:930-938. [PMID: 35790088 DOI: 10.1002/cncy.22623] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/10/2022] [Accepted: 06/20/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Metastatic breast carcinoma (mBC) is frequently encountered and may be challenging to diagnose as the tumor cells can morphologically resemble carcinomas of other primary origins. An additional challenge is that direct smears are often the only sample type available for immunostaining studies in cytology. Trichorhinophalangeal syndrome GATA-binding type 1 1 (TRPS1) is a highly sensitive marker for BC compared to the commonly used marker GATA3, especially in triple-negative BC (TNBC), in histologic samples. However, its sensitivity and specificity in mBC and other GATA3-positive tumors have not been studied. METHODS The authors identified the following cytology cases: 37 GATA3-positive mBC cases and 19 available cases that were deemed mBC but were GATA3-negative during the original case workup and five cases of each of eight epithelioid entities known to have high rates of GATA3 positivity and commonly seen in cytology practice. Immunostainings of TRPS1 and GATA3 were performed on the chosen smears following standard protocols. RESULTS TRPS1 was positive in all 37 GATA3-positive mBC cases and in 18 of the 19 GATA3-negative mBC cases. TRPS1 was negative in all five of the seven frequently GATA3-positive epithelioid entities, with the exception of salivary duct carcinomas where GATA3 was positive in a rate ranging 60%-100% among them. CONCLUSIONS TRPS1 is as sensitive as GATA3 in GATA3-positive mBC and is more sensitive than GATA3 in TNBC. TRPS1 is negative in most GATA3-positive nonbreast tumors. Thus, the combination of TRPS1 and GATA3 could be used to differentiate breast primary from others in most situations.
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Affiliation(s)
- Prih Rohra
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Cady Ding
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Esther C Yoon
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Qiong Gan
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Nikas IP, Vey JA, Proctor T, AlRawashdeh MM, Ishak A, Ko HM, Ryu HS. The Use of the International Academy of Cytology Yokohama System for Reporting Breast Fine-Needle Aspiration Biopsy. Am J Clin Pathol 2022; 159:138-145. [PMID: 36370120 PMCID: PMC9891409 DOI: 10.1093/ajcp/aqac132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 09/21/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To perform the first meta-analysis regarding the pooled risk of malignancy (ROM) of each category of the Yokohama system for reporting breast fine-needle aspiration, as well as assess the latter's diagnostic accuracy using this new system. METHODS Two databases were searched, followed by data extraction, study quality assessment, and statistical analysis. RESULTS The "Insufficient," "Benign," "Atypical," "Suspicious," and "Malignant" Yokohama system categories were associated with a pooled ROM of 17% (95% CI, 10%-28%), 1% (95% CI, 1%-3%), 20% (95% CI, 17%-23%), 86% (95% CI, 79%-92%), and 100% (95% CI, 99%-100%), respectively. When both "Suspicious" and "Malignant" interpretations were regarded as cytologically positive, sensitivity (SN) was 91% (95% CI, 87.6%-93.5%) and false-positive rate (FPR) was 2.33% (95% CI, 1.30-4.14%). A summary receiver operating characteristic curve was constructed and the pooled area under the curve was 97.3%, while the pooled diagnostic odds ratio was 564 (95% CI, 264-1,206), indicating a high level of diagnostic accuracy. When only "Malignant" interpretations were regarded as cytologically positive, the pooled FPR was lower (0.75%; 95% CI, .39%-1.42%) but at the expense of SN (76.61%; 95% CI, 70.05%-82.10%). CONCLUSIONS Despite Yokohama's system early success, more data would be needed to unravel the system's value in clinical practice.
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Affiliation(s)
| | - Johannes A Vey
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Tanja Proctor
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | | | - Angela Ishak
- School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Hyang Mi Ko
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Han Suk Ryu
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea,Department of Pathology, Seoul National University Hospital, Seoul, Korea
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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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Sundar PM, Shanmugasundaram S, Nagappan E. The role of the IAC Yokohama System for Reporting Breast Fine Needle Aspiration Biopsy and the ACR Breast Imaging-Reporting and Data System in the evaluation of breast lesions. Cytopathology 2021; 33:185-195. [PMID: 34866246 DOI: 10.1111/cyt.13085] [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: 09/05/2021] [Revised: 12/01/2021] [Accepted: 12/03/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND Stratification of breast lesions for appropriate management is achieved through an integration of clinical examination, imaging, and fine needle aspiration biopsy (FNAB). The current study aimed to evaluate the combined effectiveness of the widely used Breast Imaging-Reporting and Data System (BI-RADS) with the recently proposed International Academy of Cytology (IAC) Yokohama System for Reporting Breast Fine Needle Aspiration Biopsy Cytopathology. METHODS A retrospective analysis was done on all breast FNABs from 2016 through 2020. The cases were categorised according to the IAC Yokohama System. Histopathological correlation of the BI-RADS and IAC Yokohama System was performed. The rate of malignancy (ROM) for each category of the BI-RADS and IAC Yokohama System was calculated. RESULTS The ROM values for categories I to V were 38%, 0.6%, 21.9%, 100%, and 97%, respectively. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of FNAB with category III assumed as malignant were 98.9%, 85%, 76.1%, 99.3%, and 89.5%, respectively. With category III assumed as benign, these indices were 90.8%, 98.9%, 97.5%, 95.7%, and 96.2%, respectively. The sensitivity, specificity, PPV, NPV and accuracy of BI-RADS were 91.5%, 81.9%, 72%, 95%, and 85.1%, respectively. CONCLUSIONS FNAB is still an indispensable test in the evaluation of breast lesions. The utilisation of the IAC Yokohama reporting system for breast cytology in conjunction with ACR BI-RADS aids in better stratification of lesions.
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Affiliation(s)
| | | | - Elango Nagappan
- Department of Radiology, PSG Institute of Medical Sciences and Research, Coimbatore, India
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Ahuja S, Malviya A. Categorization of Breast Fine Needle Aspirates Using the International Academy of Cytology Yokohama System Along with Assessment of Risk of Malignancy and Diagnostic Accuracy in a Tertiary Care Centre. J Cytol 2021; 38:158-163. [PMID: 34703093 PMCID: PMC8489693 DOI: 10.4103/joc.joc_31_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 06/20/2021] [Accepted: 08/17/2021] [Indexed: 11/17/2022] Open
Abstract
Context: The International Academy of Cytology Yokohama System has developed a standardized system of reporting breast cytology by classifying them into five categories – insufficient, benign, atypical, suspicious, and malignant. Numerous studies conducted at different centers are required to confirm the risk of malignancy of the different categories. Aims: The main objectives of our study were to classify breast fine needle aspirates according to the IAC Yokohama system and assess the risk of malignancy, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. Settings and Design: It was a retrospective study done over a period of 2 years from January 2018 to December 2020. Materials and Methods: All breast FNAs done in the above period were retrieved and classified into five categories according to the Yokohama system. Histopathological diagnosis was also retrieved wherever available. Statistical Analysis Used: Using a histopathological diagnosis as the gold standard, sensitivity, specificity, PPV, NPV, and diagnostic accuracy were calculated. For each of the five categories, the risk of malignancy was also assessed. Results: Out of the 554 breast fine needle aspirates, 242 had histopathological correlation. The risk of malignancy for insufficient, benign, atypical, suspicious, and malignant categories were 5%, 1.5%, 17.4%, 81.8%, and 100%, respectively. Maximum sensitivity (97.2%) was achieved when atypical, suspicious, and malignant cases were considered as positive test results. The highest specificity (100%) was observed when only malignant cases were considered as positive test results, whereas maximum diagnostic accuracy (96.4%) was noted when the malignant and suspicious category was included in positive test results. Conclusion: The IAC Yokohama system is an excellent system for accurately diagnosing breast fine needle aspirates with greater reproducibility of reports and better communication between the pathologist and clinician.
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Affiliation(s)
- Sana Ahuja
- Department of Pathology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India
| | - Avneesh Malviya
- Department of Pathology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India
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Agrawal S, Anthony ML, Paul P, Singh D, Mehan A, Singh A, Joshi PP, Kumar A, Syed A, Ravi B, Rao S, Chowdhury N. Prospective evaluation of accuracy of fine-needle aspiration biopsy for breast lesions using the International Academy of Cytology Yokohama System for reporting breast cytopathology. Diagn Cytopathol 2021; 49:805-810. [PMID: 33755356 DOI: 10.1002/dc.24743] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/12/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Classification of breast lesions into different cytological groups can accurately be done using the International Academy of Cytology (IAC) Yokohama System for reporting breast cytopathology. Fine needle aspiration biopsy (FNAB) of breast lesions has been considered to be the primary investigation in detecting breast cancers, especially in low-cost settings. The main objective of this study was to prospectively re-confirm the diagnostic accuracy of breast FNAB using the IAC Yokohama system. Additionally, separate secondary subgroup analysis was done to confirm the accuracy of breast FNAB excluding lymph-node positive and lymphadenopathy positive tumors. MATERIAL AND METHODS A prospective study was done on patients undergoing biopsy of breast lesions between September 01, 2019 and November 30, 2020 (519 biopsies on 487 unique patients). Of these 519 histopathology biopsies, 505 had corresponding FNAB report of the same site. The FNAB was reported using the IAC Yokohama system and the most suitable category was allotted in every case. The rates of malignancy for each category and the accuracy of breast FNAB in diagnosing malignancy were calculated. RESULTS Of the total 487 patients, 120 cases were benign on histology, while 367 were malignant. The rates of malignancy in benign, atypical, suspicious and malignant categories were 5%, 25%, 71%, and 99.7%, respectively. The diagnostic accuracy of atypical, suspicious and malignant categories was calculated as 90.1%, 95.2%, and 93.3%, respectively. CONCLUSION The high diagnostic accuracy for each BIRADS category suggest excellent accuracy for Breast FNAB using the IAC Yokohama system.
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Affiliation(s)
- Shruti Agrawal
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Science, Rishikesh, Uttarkhand, India
| | - Michael Leonard Anthony
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Science, Rishikesh, Uttarkhand, India
| | - Pranoy Paul
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Science, Rishikesh, Uttarkhand, India
| | - Divya Singh
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Science, Rishikesh, Uttarkhand, India
| | - Anoushika Mehan
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Science, Rishikesh, Uttarkhand, India
| | - Ashok Singh
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Science, Rishikesh, Uttarkhand, India
| | - Prashant Pranesh Joshi
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Science, Rishikesh, Uttarkhand, India
| | - Arvind Kumar
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Science, Rishikesh, Uttarkhand, India
| | - Anjum Syed
- Integrated Breast Care Centre, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Bina Ravi
- Integrated Breast Care Centre, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Shalinee Rao
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Science, Rishikesh, Uttarkhand, India
| | - Nilotpal Chowdhury
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Science, Rishikesh, Uttarkhand, India
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Akinmoladun VI, Gbolahan OO, Aladelusi TO, Ogun GO, Ajani MA. Diagnostic Accuracy of Fine-Needle Aspiration Cytology in Head and Neck Lesions from a Tertiary Health Facility in Southwestern Nigeria. Niger Med J 2020; 61:303-306. [PMID: 33888925 PMCID: PMC8040946 DOI: 10.4103/nmj.nmj_65_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/29/2020] [Accepted: 10/20/2020] [Indexed: 11/04/2022] Open
Abstract
Background Fine-needle aspiration cytology (FNAC) is widely employed as an initial investigative tool in the diagnosis of various lesions in the body, however, it is limited in the provision of precise architectural detail of lesions. This is said to be responsible for the wide variation in the documented usefulness and accuracy relative to histopathology. This study aimed to correlate cytopathological and histopathological examination (HPE) of head and neck lesions, and assess the usefulness and accuracy of FNAC in our center. Materials and Methods This was a retrospective study that utilized historical data obtained from case notes and histopathology records of 91 patients that had both FNAC and HPE done for head and neck lesions in our center during the study. The FNAC results were correlated with that of the histopathological diagnosis to obtain the accuracy of the FNAC diagnosis. Diagnostic validity of FNAC in terms of sensitivity, specificity, and predictive value were also evaluated. Results A total of 91 FNAC-HPE sample pairs were included. The Sensitivity and specificity for benign lesion was 95.4% and 42.3%, respectively, while for sensitivity and specificity for malignant lesion was 31.8% and 96.9%, respectively. The overall Sensitivity and specificity for cytology was 96.8% and 30.4%, respectively. Conclusion FNAC appears to be a useful tool in the initial assessment of head and neck lesions in our center, however, the high rate of missed diagnosis especially as concerned malignancies has dire negative treatment implications. There is need to develop capacity for improved skill in making cytopathologic diagnoses among anatomical pathologists involved in the use of FNAC as diagnostic and screening tool.
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Affiliation(s)
- Victor I Akinmoladun
- Department of Oral and Maxillofacial Surgery, University of Ibadan/University College Hospital, Ibadan, Nigeria
| | - Olalere Omoyosola Gbolahan
- Department of Oral and Maxillofacial Surgery, University of Ibadan/University College Hospital, Ibadan, Nigeria
| | - Timothy O Aladelusi
- Department of Oral and Maxillofacial Surgery, University of Ibadan/University College Hospital, Ibadan, Nigeria
| | - Gabriel O Ogun
- Department of Pathology, University of Ibadan/University College Hospital, Ibadan, Nigeria
| | - Mustapha A Ajani
- Department of Pathology, University of Ibadan/University College Hospital, Ibadan, Nigeria
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Agarwal A, Singh D, Mehan A, Paul P, Puri N, Gupta P, Syed A, Rao S, Chowdhury N, Ravi B. Accuracy of the International Academy of Cytology Yokohama system of breast cytology reporting for fine needle aspiration biopsy of the breast in a dedicated breast care setting. Diagn Cytopathol 2020; 49:195-202. [PMID: 33017520 DOI: 10.1002/dc.24632] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 09/17/2020] [Accepted: 09/24/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND The International Academy of Cytology (IAC) Yokohama system is a recently proposed system for reporting breast cytology by fine needle aspiration biopsies (FNAB). Multiple studies are needed to confirm the risk of malignancy (ROM) of the various reporting categories of this system. The present article studies the accuracy of the IAC Yokohama system in our center. METHODS Over a period of 1 year (September 2018-August 2019), all cases of breast masses assessed by FNAB and histological correlation were studied retrospectively. Sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) and overall accuracy of the IAC Yokohama system for diagnosing malignancy were assessed. The rates of malignancy (ROM) of each diagnostic category were also estimated. RESULTS Three hundred and twenty-one FNABs had cyto-histological correlation. The percent sensitivity (with 95% Confidence Intervals) when the atypical, suspicious of malignancy and the malignant categories were regarded as positive for malignancy were 98.2% [95.5%, 99.5%], 96.0% [92.5%, 98.2%], and 86.7% [81.5%, 90.8%] respectively. The percent specificity (with 95% Confidence intervals) for the same categories in the same order were 59.5% [47.4%, 70.7%], 91.9% [83.2%, 97.0%], and 100% [95.1%, 100%] respectively. The area under curve (AUC) for diagnosing malignancy was 0.981[0.963, 0.993]. The ROM for the benign, atypical, suspicious of malignancy and malignant category were 8.3% [2.3%, 20.0%], 17.2% [5.8%, 35.8%], 77.8% [57.7%, 91.4%], and 100% [98.1%, 100%] respectively. CONCLUSION The IAC Yokohama system is suitable for accurately reporting breast lesions on FNAB.
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Affiliation(s)
- Akansha Agarwal
- Integrated Breast Care Centre and Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Divya Singh
- Integrated Breast Care Centre and Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Anoushika Mehan
- Integrated Breast Care Centre and Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Pranoy Paul
- Integrated Breast Care Centre and Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Neeti Puri
- Integrated Breast Care Centre and Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Priyanka Gupta
- Integrated Breast Care Centre and Department of radiodiagnosis, All India Institute of Medical Sciences, , Rishikesh, India
| | - Anjum Syed
- Integrated Breast Care Centre and Department of radiodiagnosis, All India Institute of Medical Sciences, , Rishikesh, India
| | - Shalinee Rao
- Integrated Breast Care Centre and Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Nilotpal Chowdhury
- Integrated Breast Care Centre and Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Bina Ravi
- Integrated Breast Care Centre and Department of Surgery, All India Institute of Medical Sciences, Rishikesh, India
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