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Folarin O, Kim D, Gokozan HN, Heymann JJ, Scarpa Carniello JV, Rosado L, Siddiqui MT, Patel A. Interobserver agreement and risk of malignancy using the International Academy of Cytology Yokohama System for reporting breast FNA biopsy in a liquid-based exclusive cohort. Cancer Cytopathol 2024; 132:320-326. [PMID: 38410851 DOI: 10.1002/cncy.22798] [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: 10/07/2023] [Revised: 12/21/2023] [Accepted: 01/04/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND Per the College of American Pathologist's National Breast Fine Needle Aspiration Biopsy (FNAB) Practice Survey, ∼40% of laboratories use liquid-based cytology (LBC) for breast FNAB. The reproducibility of the International Academy of Cytology Yokohama System (YS) for reporting breast FNAB on LBC was explored. DESIGN Breast FNAB specimens submitted as LBC only (all ThinPrep) between January 2017 and January 2021 were retrieved. Cases without histopathologic follow-up were excluded. Clinical and radiologic information was collected. One cytologist and six cytopathologists rendered diagnoses per YS. All reviewers were blinded to the original diagnosis and histopathologic follow-up. The risk of malignancy was calculated. Concordance rates were calculated by a weighted Cohen Kappa score (κ). RESULTS Review of 110 cases demonstrated substantial to near-perfect agreement between each reviewer (κ = 0.73-0.91) and follow-up histopathology (κ = 0.66-0.85). The agreement was lowest in the inadequate (κ = 0.05) and atypical (κ = 0.04) categories. The lack of concordance in the atypical category was common in cases with low cellularity or incomplete structural features. The risk of malignancy for inadequate, benign, atypical, suspicious for malignancy, and malignant categories were 12.5% (2/16), 3% (2/65), 67%, (8/12) 100% (1/1), and 100% (16/16). CONCLUSION Interobserver agreement is excellent using the five YS categories in LBC. Lack of cellularity and incomplete architectural features were barriers to perfect agreement. Established pitfalls in the interpretation of LBC were cause for atypical diagnoses. Continuous training and education are recommended to avoid misdiagnosis because of the nonconventional cytomorphologic features of LBC and to improve inadequate and atypical rates within YS.
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Affiliation(s)
- Olawunmi Folarin
- New York Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - David Kim
- New York Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Hamza N Gokozan
- New York Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Jonas J Heymann
- New York Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | | | - Lucelina Rosado
- New York Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Momin T Siddiqui
- New York Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Ami Patel
- New York Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
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Franzén B, Auer G, Lewensohn R. Minimally invasive biopsy-based diagnostics in support of precision cancer medicine. Mol Oncol 2024. [PMID: 38519839 DOI: 10.1002/1878-0261.13640] [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: 09/29/2023] [Revised: 01/31/2024] [Accepted: 03/14/2024] [Indexed: 03/25/2024] Open
Abstract
Precision cancer medicine (PCM) to support the treatment of solid tumors requires minimally invasive diagnostics. Here, we describe the development of fine-needle aspiration biopsy-based (FNA) molecular cytology which will be increasingly important in diagnostics and adaptive treatment. We provide support for FNA-based molecular cytology having a significant potential to replace core needle biopsy (CNB) as a patient-friendly potent technique for tumor sampling for various tumor types. This is not only because CNB is a more traumatic procedure and may be associated with more complications compared to FNA-based sampling, but also due to the recently developed molecular methods used with FNA. Recent studies show that image-guided FNA in combination with ultrasensitive molecular methods also offers opportunities for characterization of the tumor microenvironment which can aid therapeutic decisions. Here we provide arguments for an increased implementation of molecular FNA-based sampling as a patient-friendly diagnostic method, which may, due to its repeatability, facilitate regular sampling that is needed during different treatment lines, to provide tumor information, supporting treatment decisions, shortening lead times in healthcare, and benefit healthcare economics.
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Affiliation(s)
- Bo Franzén
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Cancer Centre Karolinska (CCK) Foundation, Karolinska University Hospital, Stockholm, Sweden
| | - Gert Auer
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Rolf Lewensohn
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Theme Cancer, Medical Unit Head and Neck, Lung, and Skin Tumors, Thoracic Oncology Center, Karolinska University Hospital, Stockholm, Sweden
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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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Chen Z, Salibay C, Elatre W, Naritoku WY, Ma Y, Martin SE, Wang T. Performance of breast fine needle aspiration as an initial diagnostic tool: A large academic hospital experience. Cytopathology 2022; 33:707-715. [PMID: 35869577 PMCID: PMC9826159 DOI: 10.1111/cyt.13171] [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: 03/31/2022] [Revised: 07/14/2022] [Accepted: 07/18/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND The clinical performance of the Yokohama reporting system for breast cytology remains uncertain. METHODS In this study, we retrospectively evaluated 318 breast fine needle aspirations (FNABs) from Los Angeles County Hospital over a five-year period, analysing data for breast cytology, histology, and radiology. RESULTS Among 318 breast FNAB cases, 78.3% (249/318) were benign and 5.3% (17/318) malignant. Of 83 cases with follow-up histology, 14.5% (12/83) were insufficient, 66.3% (55/83) were benign, and 16.9% (17/83) were malignant. Of 55 benign cases, 61.8% (34/55) were fibroadenoma and 9 (9/55, 16.4%) were fibrocystic changes. Two cases were diagnosed as "atypical" but confirmed "benign" on core needle biopsy (CNB). No "suspicious" cases were found. Seventeen malignant cases were confirmed by CNB, including 70.6% (12/17) invasive ductal carcinoma, 11.8% (2/17) invasive lobular carcinoma, and one malignant phyllodes tumour. Receptor studies on cell blocks of three malignant cases showed concordant results with CNB results. In addition, 82.2% (148/180) of lesions with Breast Imaging-Reporting and Data System (BI-RADS) scores of 2 or 3 were benign and 92.3% (12/13) BI-RADS score 5 lesions were malignant on FNAB. Finally, 90% (67/74) of BI-RADS 4a lesions were benign, and 97% (36/37) of fibroadenomas were BI-RADS score 4a. CONCLUSION This, by far the largest U.S. breast cytology study, showed 93.3% sensitivity, 100% specificity, 100% positive predictive value, and 98.2% negative predictive value for breast FNAB. Women with breast lesions of BI-RADS score 3 or less have a low risk of malignancy; FNAB would contribute to the reduction of excisional biopsies. FNAB can be considered as an initial diagnostic tool for BI-RADS 4 mass/lesions and satellite lesions, as well as for triaging patients.
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Affiliation(s)
- Zhengshan Chen
- Department of Pathology and Laboratory MedicineUniversity of Southern California/LAC‐USC Medical CenterLos AngelesCaliforniaUSA
| | - Christine Salibay
- Department of Pathology and Laboratory MedicineUniversity of Southern California/LAC‐USC Medical CenterLos AngelesCaliforniaUSA
| | - Wafaa Elatre
- Department of Pathology and Laboratory MedicineUniversity of Southern California/LAC‐USC Medical CenterLos AngelesCaliforniaUSA
| | - Wesley Y. Naritoku
- Department of Pathology and Laboratory MedicineUniversity of Southern California/LAC‐USC Medical CenterLos AngelesCaliforniaUSA
| | - Yanling Ma
- Department of Pathology and Laboratory MedicineUniversity of Southern California/LAC‐USC Medical CenterLos AngelesCaliforniaUSA
| | - Sue Ellen Martin
- Department of Pathology and Laboratory MedicineUniversity of Southern California/LAC‐USC Medical CenterLos AngelesCaliforniaUSA
| | - Tiannan Wang
- Department of Pathology and Laboratory MedicineUniversity of Southern California/LAC‐USC Medical CenterLos AngelesCaliforniaUSA
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Cserni G, Francz M, Járay B, Kálmán E, Kovács I, Krenács T, Tóth E, Udvarhelyi N, Vass L, Vörös A, Krivokuca A, Kajo K, Kajová Macháleková K, Kulka J. Pathological Diagnosis, Work-Up and Reporting of Breast Cancer 1st Central-Eastern European Professional Consensus Statement on Breast Cancer. Pathol Oncol Res 2022; 28:1610373. [PMID: 35845921 PMCID: PMC9284216 DOI: 10.3389/pore.2022.1610373] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/29/2022] [Indexed: 12/18/2022]
Abstract
This text is based on the recommendations accepted by the 4th Hungarian Consensus Conference on Breast Cancer, modified on the basis of the international consultation and conference within the frames of the Central-Eastern European Academy of Oncology. The recommendations cover non-operative, intraoperative and postoperative diagnostics, determination of prognostic and predictive markers and the content of cytology and histology reports. Furthermore, they address some specific issues such as the current status of multigene molecular markers, the role of pathologists in clinical trials and prerequisites for their involvement, and some remarks about the future.
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Affiliation(s)
- Gábor Cserni
- Department of Pathology, Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary
- Institute of Pathology, University of Szeged, Szeged, Hungary
- *Correspondence: Gábor Cserni,
| | - Monika Francz
- Department of Pathology, Szabolcs-Szatmár-Bereg County Hospitals and University Teaching Hospital, “Jósa András” Teaching Hospital, Nyíregyháza, Hungary
| | | | - Endre Kálmán
- Institute of Pathology, University of Pécs, Pécs, Hungary
| | - Ilona Kovács
- Department of Pathology, University of Debrecen, “Kenézy Gyula” University Hospital, Debrecen, Hungary
| | - Tibor Krenács
- Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Erika Tóth
- Department of Pathology, National Institute of Oncology, Budapest, Hungary
| | - Nóra Udvarhelyi
- Department of Pathology, National Institute of Oncology, Budapest, Hungary
| | - László Vass
- Department of Pathology, Pest County “Flór Ferenc” University Teaching Hospital, Kistarcsa, Hungary
| | - András Vörös
- Institute of Pathology, University of Szeged, Szeged, Hungary
| | - Ana Krivokuca
- Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Karol Kajo
- Department of Pathology, St. Elisabeth Cancer Institute, Bratislava, Slovakia
| | | | - Janina Kulka
- Department of Pathology, Forensic and Insurance Medicine, Semmelweis University, Budapest, Hungary
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Niaz M, Khan AA, Ahmed S, Rafi R, Salim H, Khalid K, Kazi F, Anjum A, Waheed Y. Risk of Malignancy in Breast FNAB Categories, Classified According to the Newly Proposed International Academy of Cytology (IAC) Yokohama System. Cancer Manag Res 2022; 14:1693-1701. [PMID: 35573260 PMCID: PMC9093610 DOI: 10.2147/cmar.s362155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/08/2022] [Indexed: 11/23/2022] Open
Abstract
Background A new category system comprising five classes (C1-insufficient material, C2-benign, C3-atypical, C4-suspicious, and C5-malignant) has been proposed by the International Academy of Cytology (IAC) for fine needle aspiration biopsy cytology (FNAB) for proper diagnosis of breast cancer. Aims and Objectives This study is designed to categorize institutional FNAB data according to the new system and calculation of the absolute risk of malignancy (ROM), sensitivity, specificity, positive predictive values, false negative and false-positive rate. Study Design We conducted a retrospective cross-sectional study involving 2133 cases collected between June, 2008 and August, 2019, at Foundation University Medical College’s Department of Histopathology and the Surgery and Oncology Department at the Fauji Foundation Hospital. All cases fulfilling the inclusion and exclusion criteria were retrieved from the archives and reviewed by two expert pathologists. Matching histopathology was compared with the cytology reports for concordance or discordance of results. Findings We found 6.9% (n = 147) insufficient, 65.8% (n = 1403) benign, 7.2% (n = 153) atypical, 7.5% (n = 160) suspicious and 12.6% (n = 270) malignant cases. Cyto-histological correlation was found in 421 cases from the year 2014 to 2019 with 370 concordant and 51 discordant cases. The maximum number of concordant cases was 151 in the C5 category and discordant cases had a diagnosis of C3 and C4 on cytology with 16 cases in each category. The calculated values of ROM were 45.45%, 10.3%, 30.6%, 82.79% and 99.34% from C1 to C5, respectively. We calculated 83.42% absolute sensitivity and 85.24% specificity. The positive predictive value for category 3, 4 and 5 was 67.34%, 82.7% and 99.34%, respectively, while false-negative rate was 7.9% and false-positive rate was 0.66%. Conclusion The ROM for C1 category calculated from this study is quite high (45.45%) compared to previous studies; therefore, it is recommended to perform core needle biopsy in all these cases. The higher sensitivity and specificity of this method of diagnosing malignant lesions supports its use.
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Affiliation(s)
- Mahwish Niaz
- Department of Pathology, Foundation University Medical College, Foundation University Islamabad, Islamabad, Pakistan
- Department of Pathology, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Azmat Ali Khan
- Pharmaceutical Biotechnology Laboratory, Department of Pharmaceutical Chemistry, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Safina Ahmed
- Department of Pathology, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Rabia Rafi
- Department of Pathology, Isfand Bukhari District Hospital, Attock, Pakistan
| | - Hassan Salim
- Department of Medicine, Fauji Foundation Hospital, Rawalpindi, Pakistan
| | - Kashaf Khalid
- Clinical and Biomedical Research Center, Foundation University Medical College, Foundation University Islamabad, Islamabad, Pakistan
| | - Faiza Kazi
- Department of Pathology, Foundation University Medical College, Foundation University Islamabad, Islamabad, Pakistan
- Department of Pathology, PAEC Hospital, Islamabad, Pakistan
| | | | - Yasir Waheed
- Clinical and Biomedical Research Center, Foundation University Medical College, Foundation University Islamabad, Islamabad, Pakistan
- Correspondence: Yasir Waheed, Clinical and Biomedical Research Center, Foundation University Medical College, Foundation University Islamabad, DHA-1, Islamabad, Pakistan, Email
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7
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Pinto D, Schmitt FC. Immunohistochemistry Applied to Breast Cytological Material. Pathobiology 2022; 89:343-358. [PMID: 35367980 DOI: 10.1159/000522542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 02/08/2022] [Indexed: 12/19/2022] Open
Abstract
Fine-needle aspiration biopsies (FNABs) of the breast are minimally invasive procedures enabling the diagnosis of suspicious breast lesions. Unfortunately, they are often perceived as inferior to core-needle biopsies, namely because they are supposedly unable to differentiate between high-grade ductal carcinoma in situ and invasive carcinoma or provide material for ancillary testing. Several studies have shown, however, that FNAB samples, when handled properly, are indeed capable of providing sufficient and adequate material for ancillary testing, namely immunocytochemistry (ICC). We reviewed the published literature regarding the use of ICC for both diagnostic and theranostic uses in the different types of cytological samples obtained from FNABs of the breast, including smears, liquid-based cytology samples, and cellblocks. We found that p63 and 34βE12 show promise in aiding in the differential diagnosis between in situ and invasive lesions and that most other diagnostic markers may be used as in tissue. Regarding theranostic ICC markers, results vary between publications, but with care, these can successfully be performed in cytological samples. Air-dried smears should be avoided, and cellblocks are overall more versatile than cytology slides, enabling the evaluation of not only hormonal receptors and HER2 by ICC, but also of Ki-67. Particular attention should be paid to fixation and antigen retrieval procedures in all cases. We recommend that laboratories without experience perform short validation runs before adopting these techniques into clinical practice.
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Affiliation(s)
- Daniel Pinto
- Serviço de Anatomia Patológica, Centro Hospitalar de Lisboa Ocidental, EPE, Lisboa, Portugal.,NOVA Medical School, Lisboa, Portugal.,IPATIMUP-Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Porto, Portugal
| | - Fernando C Schmitt
- IPATIMUP-Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Porto, Portugal.,Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,RISE (Health Research Network) @ CINTESIS (Center for Health Technology and Services Research), Porto, Portugal
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8
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Rohilla M, Srinivasan R. Cytopathology of Breast Cancer. Breast Cancer 2022. [DOI: 10.1007/978-981-16-4546-4_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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9
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Nigam JS, Kumar T, Bharti S, Surabhi, Sinha R, Bhadani PP. The International Academy of Cytology standardized reporting of breast fine-needle aspiration biopsy cytology: A 2 year's retrospective study with application of categories and their assessment for risk of malignancy. Cytojournal 2021; 18:27. [PMID: 34876918 PMCID: PMC8645495 DOI: 10.25259/cytojournal_43_2020] [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: 07/04/2020] [Accepted: 06/07/2021] [Indexed: 11/04/2022] Open
Abstract
Objectives Breast cancer is the most common cancer in women worldwide. The fine-needle aspiration biopsy (FNAB) may be used as the first-line pathological investigation for evaluation and early diagnosis of the breast lesion. The FNAB helps to differentiate malignant from benign lesions. In the present study, we categorized the breast FNAB cases according to the International Academy of Cytology Yokohama System (IACYS) for reporting breast FNAB cytology and to assess the risk of malignancy (ROM) for each category. Material and Methods A retrospective data of breast lesions were retrieved from the archives of pathology department between January 2018 and December 2019. The study got approval from the Institutional Ethics Committee. Only 123 cases with cytology and histopathological correlation were included in this study. The cytological category was given according to IACYS for reporting breast FNAB cytology. Results The FNAB results were include as insufficient material 3.25% (4/123), benign 46.34% (57/123), atypical 12.2% (15/123), suspicious for malignancy (SM) 4.88% (6/123), and malignant 33.33% (41/123). The ROM was 50%, 7.27%, 40.0%, 83.33%, and 97.5% for NS, benign, atypical, SM, and malignant, respectively. Conclusion FNAB is an important tool in the diagnosis and management of breast lesions, especially in financial constrained developing countries like India with limited resources, where practice of core needle biopsy is limited. The 5-tier IACYS for reporting breast FNAB improves the reproducibility of cytology reports across the world and helps in triaging the breast lesion patients.
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Affiliation(s)
- Jitendra Singh Nigam
- Department of Pathology / Lab Medicine, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Tarun Kumar
- Department of Pathology / Lab Medicine, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Shreekant Bharti
- Department of Pathology / Lab Medicine, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Surabhi
- Department of Pathology / Lab Medicine, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Ruchi Sinha
- Department of Pathology / Lab Medicine, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Punam Prasad Bhadani
- Department of Pathology / Lab Medicine, All India Institute of Medical Sciences, Patna, Bihar, 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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11
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Torous VF, Lopez SH, Xu C, Sweeney BJ, Pitman MB. Performance of Rapid On-Site Evaluation in Breast Fine-Needle Aspiration Biopsies: Identifying Areas of Diagnostic Challenge. Acta Cytol 2021; 66:1-13. [PMID: 34816801 DOI: 10.1159/000518579] [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: 05/18/2021] [Accepted: 07/15/2021] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Fine-needle aspiration (FNA) is a well-established method for sampling breast lesions with high accuracy and positive predictive value. Despite its decline in recent years relative to the use of core needle biopsies, there are several advantages to FNA which include cost-effectiveness, low complication rate, and the ability to perform rapid on-site evaluation (ROSE). The aim of this study was to evaluate breast FNAs with ROSE to identify diagnostic challenges during ROSE. MATERIALS AND METHODS We identified all breast FNAs with ROSE performed at Massachusetts General Hospital from January 2014 to December 2019. From the electronic medical record, clinical, radiological, and follow-up pathology results were recorded. Comparison between the rapid and final cytological diagnosis was made. All discrepancies were documented with major discrepancy defined as a malignant rapid interpretation not confirmed on final diagnosis or a negative rapid interpretation upgraded to suspicious or positive on final diagnosis. RESULTS The study cohort consisted of 483 breast FNAs with ROSE. The rapid and final cytological interpretations showed good correlation, with only 6 (1.2%) major discrepancies. Problematic areas included low-grade, lobular, and fibroepithelial lesions with low cellularity being a contributory factor to misclassification. CONCLUSIONS FNA remains a highly accurate method for the evaluation of breast lesions with ROSE.
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Affiliation(s)
- Vanda F Torous
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | | | - Christine Xu
- Harvard Medical School, Boston, Massachusetts, USA
| | - Brenda J Sweeney
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Martha B Pitman
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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12
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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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14
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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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15
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Agrawal S, Anthony ML, Paul P, Singh D, Agarwal A, Mehan A, Singh A, Joshi PP, Kumar A, Syed A, Ravi B, Rao S, Chowdhury N. Accuracy of Breast Fine-Needle Aspiration Biopsy Using the International Academy of Cytology Yokohama System in Clinico-Radiologically Indeterminate Lesions: Initial Findings Demonstrating Value in Lesions of Low Suspicion of Malignancy. Acta Cytol 2021; 65:220-226. [PMID: 33906188 DOI: 10.1159/000515914] [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: 02/08/2021] [Accepted: 03/14/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Fine-needle aspiration biopsy (FNAB) in breast lesions offers accurate results in differentiating benign and malignant lesions. However, its role is unclear when core-needle biopsy (CNB) is available, the latter providing additional information regarding tumor grade, invasion, and hormone receptor status in malignant lesions. In benign breast lesions, especially in BIRADS category 4a and 4b, FNAB, and CNB provide similar pathological information, whereby FNAB may serve as a more rapid and cost-effective investigation. The study was planned to reevaluate the diagnostic accuracy of FNAB in BIRADS category 4a, 4b, and 4c lesions. MATERIALS AND METHODS FNAB and biopsy reports of all patients with breast lesions sent between September 1, 2018, and November 30, 2020, were collected and the International Academy of Cytology (IAC) Yokohama category and BIRADS score were recorded for each case. The rate of malignancy and the accuracy of FNAB in diagnosing malignancy were calculated for each BIRADS 4a, 4b, and 4c subgroup. RESULTS A total of 249 cases of BIRADS 4 lesions had corresponding cytology and histopathology diagnoses. FNAB showed high diagnostic accuracy in all BIRADS groups. A benign categorization was associated with a very low number of false-negative diagnoses, especially in BIRADS 4a lesions. CONCLUSION The study reconfirms the excellent accuracy of breast FNAB using the IAC Yokohama system in diagnosing breast malignancies. Furthermore, BIRADS 4a lesions found to be belonging to the cytological benign category may be excluded from CRB and kept on clinical follow-up.
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Affiliation(s)
- Shruti Agrawal
- Department of Pathology and Laboratory Medicine, AIIMS, Rishikesh, India,
| | | | - Pranoy Paul
- Department of Pathology and Laboratory Medicine, AIIMS, Rishikesh, India
| | - Divya Singh
- Department of Pathology and Laboratory Medicine, AIIMS, Rishikesh, India
| | - Akansha Agarwal
- Department of Pathology and Laboratory Medicine, AIIMS, Rishikesh, India
| | - Anoushika Mehan
- Department of Pathology and Laboratory Medicine, AIIMS, Rishikesh, India
| | - Ashok Singh
- Department of Pathology and Laboratory Medicine, AIIMS, Rishikesh, India
| | | | - Arvind Kumar
- Department of Pathology and Laboratory Medicine, AIIMS, Rishikesh, India
| | - Anjum Syed
- Integrated Breast Care Centre and Department of Radiodiagnosis, AIIMS, Rishikesh, India
| | - Bina Ravi
- Integrated Breast Care Centre and Department of Surgery, AIIMS, Rishikesh, India
| | - Shalinee Rao
- Department of Pathology and Laboratory Medicine, AIIMS, Rishikesh, India
| | - Nilotpal Chowdhury
- Department of Pathology and Laboratory Medicine, AIIMS, Rishikesh, India
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16
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Dinarvand P, Liu C, Roy-Chowdhuri S. A decade of change: Trends in the practice of cytopathology at a tertiary care cancer centre. Cytopathology 2021; 32:604-610. [PMID: 33792972 DOI: 10.1111/cyt.12972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/26/2021] [Accepted: 03/01/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The practice of cytopathology has evolved over the past decade with a growing need for doing more with less tissue. Changes in clinical practice guidelines and evolving needs in tissue acquisition for diagnosis and treatment have affected various areas of cytopathology in different ways. In this study, we evaluated the changing trends in cytopathological practice at our institution over the past decade. METHODS We performed a retrospective review of our institutional database for cytopathology cases from calendar years 2009 (n = 28038) and 2019 (n = 31386) to evaluate the changing trends in practice. RESULTS The overall number of exfoliative cases decreased 10% over the past decade, primarily due to a 64% decrease in gynaecological Pap testing. However, the volume of serous body cavity and cerebrospinal fluids increased 125% and 44%, respectively. The overall volume of fine needle aspiration (FNA) cases increased 38% from 2009 to 2019. The number of FNA cases increased across most body sites, driven primarily by a 180% increase in endobronchial ultrasound-guided transbronchial needle aspiration cases. In contrast, breast FNA volume decreased 43%. Ancillary studies increased substantially over the past decade, including immunostains (476%) and molecular testing (250%). CONCLUSIONS The trends in our cytopathological practice showed an increased volume of cases, especially in non-gynaecological specimens. As expected, the number of FNA cases used for immunostains and molecular testing increased substantially, indicating an upward trend in ancillary studies in cytopathological practice.
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Affiliation(s)
- Peyman Dinarvand
- Department of Pathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Chinhua Liu
- Department of Pathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sinchita Roy-Chowdhuri
- Department of Pathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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17
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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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18
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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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Embaye KS, Raja SM, Gebreyesus MH, Ghebrehiwet MA. Distribution of breast lesions diagnosed by cytology examination in symptomatic patients at Eritrean National Health Laboratory, Asmara, Eritrea: a retrospective study. BMC WOMENS HEALTH 2020; 20:250. [PMID: 33172446 PMCID: PMC7654611 DOI: 10.1186/s12905-020-01116-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 11/03/2020] [Indexed: 11/10/2022]
Abstract
Background Fine needle aspiration cytology is a simple, relatively accurate, non-invasive, and cost-effective method of diagnosing most breast pathologies. To date, there is no sufficient data depicting the distribution of breast lesions detected by fine needle aspiration cytology in our healthcare setting. The aim of this study was to elucidate the general distribution of breast lesions diagnosed by cytology test at Eritrean National Health Laboratory.
Methods This retrospective study was carried out on 905 symptomatic patients between the years 2013 and 2017 at Eritrean National Health Laboratory. Diagnosis was made by fine needle aspiration cytology in patients with palpable breast lump and in some patients direct smear was prepared from a nipple discharge. Statistical analysis was carried out using Statistical Package for the Social Sciences version 23. Results A total of 905 patients were included in the study, of whom 871 (96.24%) were females. The age range of patients was from 13 to 93 years with mean and standard deviation of 33 ± 14.9 years. Breast lump, occurring in 892 (98.56%), was the most frequent presenting symptom. Fibroadenoma and fibrocystic breast lesions were the most prevalent lesions accounting for approximately 40% and 15%, respectively. Malignant breast lesions were seen predominantly in females above the age of 40 years with the highest frequency observed in the age range between 51 and 60 years. Pearson Chi-squared test showed significant association between patients’ age above 40 years and the risk of having a malignant breast lesion (p < 0.001). The highest number of benign and malignant breast lesions was documented in 2014 with little fluctuation elsewhere in the study period. Conclusion Fine needle aspiration cytology is a procedure of choice for preoperative diagnosis in breast lesions mainly in a resource-limited settings. Our study identified the occurrence of malignant breast lesions in young women, which is of a paramount public health concern. Of note, significant proportion of patients were late to seek medical attention. Therefore, enhancement of community awareness regarding breast disease and implementation of screening programs are necessary to ameliorate the morbidity and mortality associated with the disease.
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Affiliation(s)
- Kidane Siele Embaye
- Department of Basic Medicine, Orotta School of Medicine and Dentistry, Asmara, Eritrea.
| | - Saud Mohammed Raja
- Department of Internal Medicine, Orotta School of Medicine and Dentistry, Asmara, Eritrea
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20
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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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21
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Pinto D, Schmitt F. The role of breast fine needle aspiration during and post-COVID-19 pandemic: A fast and safe alternative to needle core biopsy. Cytopathology 2020; 31:627-629. [PMID: 32705731 PMCID: PMC7405266 DOI: 10.1111/cyt.12894] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/12/2020] [Accepted: 07/17/2020] [Indexed: 12/13/2022]
Abstract
Fine needle aspiration (FNA) may be used to study breast lesions in patients that do not have access to more complex procedures during the COVID‐19 pandemic. Furthermore, FNA can be a helpful screening method in the post‐pandemic era when a greater number of patients than usual with delayed treatment can overburden clinics and hospitals.
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Affiliation(s)
- Daniel Pinto
- Serviço de Anatomia Patológica, Centro Hospitalar de Lisboa Ocidental, EPE, Lisboa, Portugal.,NOVA Medical School, Lisboa, Portugal
| | - Fernando Schmitt
- IPATIMUP-Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Porto, Portugal.,Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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22
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De Rosa F, Migliatico I, Vigliar E, Salatiello M, Pisapia P, Iaccarino A, Russo D, Insabato L, Accurso A, Arpino G, Palombini L, Troncone G, Bellevicine C. The continuing role of breast fine‐needle aspiration biopsy after the introduction of the IAC Yokohama System For Reporting Breast Fine Needle Aspiration Biopsy Cytopathology. Diagn Cytopathol 2020; 48:1244-1253. [DOI: 10.1002/dc.24559] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/23/2020] [Accepted: 07/09/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Filippo De Rosa
- Department of Public Health University of Naples Federico II Naples Italy
| | - Ilaria Migliatico
- Department of Public Health University of Naples Federico II Naples Italy
| | - Elena Vigliar
- Department of Public Health University of Naples Federico II Naples Italy
| | - Maria Salatiello
- Department of Public Health University of Naples Federico II Naples Italy
| | - Pasquale Pisapia
- Department of Public Health University of Naples Federico II Naples Italy
| | - Antonino Iaccarino
- Department of Public Health University of Naples Federico II Naples Italy
| | - Daniela Russo
- Department of Advanced Biomedical Sciences University of Naples Federico II Naples Italy
| | - Luigi Insabato
- Department of Advanced Biomedical Sciences University of Naples Federico II Naples Italy
| | - Antonello Accurso
- Department of Surgery, Breast Unit University of Naples Federico II Naples Italy
| | - Grazia Arpino
- Department of Clinical Medicine and Surgery University of Naples Federico II Naples Italy
| | - Lucio Palombini
- Department of Public Health University of Naples Federico II Naples Italy
| | - Giancarlo Troncone
- Department of Public Health University of Naples Federico II Naples Italy
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23
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Layfield LJ, Wang G, Yang ZJ, Gomez-Fernandez C, Esebua M, Schmidt RL. Interobserver Agreement for the International Academy of Cytology Yokohama System for Reporting Breast Fine-Needle Aspiration Biopsy Cytopathology. Acta Cytol 2020; 64:413-419. [PMID: 32428908 DOI: 10.1159/000506757] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 02/23/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND A number of guidelines have been developed to improve standardization of the terminology and criteria for cytologic specimens obtained from the thyroid, pancreas, lung, and salivary glands. A major goal of these guidelines is to improve reproducibility and understanding of the reporting of diagnostic results among cytopathologists and between cytopathologists and clinicians. The International Academy of Cytology Yokohama System for Reporting Breast Fine-Needle Aspiration Biopsy Cytopathology (IAC YSRB) is the most recent of these guidelines. The value of this system is, in part, dependent upon interobserver reproducibility. DESIGN Ninety consecutive fine-needle aspiration biopsies (FNAB) of the breast, performed over a 6-year period, were independently evaluated by 4 board-certified pathologists blinded to the original diagnoses. The 5 diagnostic categories used were those of the IAC YSRB according to published criteria for these categories. Observed agreement and chance corrected agreement (Fliess κ) were calculated. Differences in κ values were evaluated using the T statistic of Gwent. Statistical calculations were performed using STATA v16.0 (STATA Corp., College Station, TX, USA). RESULTS Overall agreement between observers was good. Observed unweighted agreement was 69% and weighted agreement was 91%. The majority of diagnoses were concordant (68.6%). CONCLUSIONS Interobserver agreement of 4 cytopathologists was good using the 5 categories of the IAC YRSB (69%). Agreement was greater among pathologists with more years of experience. The IAC YSRB system appears to provide greater agreement among viewers than guidelines for cytologic specimens obtained from some other body sites (salivary gland and lung). Most discrepancies were only by a single category, with only 22/113 (19%) differing by more than one category.
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Affiliation(s)
- Lester J Layfield
- Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, Missouri, USA,
| | - Guoliang Wang
- Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, Missouri, USA
| | - Zhongbo Jerry Yang
- Department of Pathology, Rosewell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Carmen Gomez-Fernandez
- University of Miami Hospital, University of Miami School of Medicine, Miami, Florida, USA
| | - Magda Esebua
- Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, Missouri, USA
| | - Robert L Schmidt
- University of Utah Health Care and ARUP Laboratories, Salt Lake City, Utah, USA
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24
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Krishnamurthy S. Relevance and impact of the International Academy of Cytology Yokohama System for standardized reporting of breast fine-needle aspiration biopsy cytology. J Am Soc Cytopathol 2020; 9:63-66. [PMID: 32033919 DOI: 10.1016/j.jasc.2019.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 12/03/2019] [Indexed: 01/05/2023]
Affiliation(s)
- Savitri Krishnamurthy
- Deputy Division Head and Director for Clinical Trials, Research and Development, Division of Pathology and Lab Medicine, Houston, Texas.
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25
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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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26
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Is core needle biopsy effective at diagnosing male breast lesions? Breast Cancer Res Treat 2019; 177:507-511. [PMID: 31168757 DOI: 10.1007/s10549-019-05312-x] [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: 05/28/2019] [Accepted: 06/01/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The objective of this study was to examine the diagnostic accuracy of sonographically guided core needle biopsy (CNB) of breast lesions in men. METHODS This was a retrospective study where we analyzed consecutive sonographically guided 14-gauge CNB results on 234 male breast lesions. The CNB accuracy is determined by the comparison between the CNB and its corresponding excisional biopsy or to long-term follow-up imaging. RESULTS Sonographically guided CNB was effective to collect satisfactory samples from all 234 lesions. Out of those, 58.55% (137/234) were benign, 38.0% (89/234) were malignant, 1.71% (4/234) were papilloma with atypia and 1.71% (4/234) were atypical ductal hyperplasia lesions. Underestimation occurred in 3.4% (8/234) of the lesions. As for the detection of breast malignancy, the sensitivity of the CNB is 98.9%, specificity is 100%, negative predictive value is 99.3%, positive predictive value is 100%, false positive is 0% and false negative is 1.1%. The overall accuracy of sonographically guided CNB as a diagnostic tool is 99.6%. CONCLUSION Sonographically guided 14-gauge CNB is an accurate, reliable and low invasive procedure for assessing breast lesions in men. Triple tests and follow-up checks of benign cases are essential for a successful breast biopsy program in men.
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27
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Field AS, Raymond WA, Schmitt FC. The International Academy of Cytology Yokohama System for Reporting Breast Fine Needle Aspiration Biopsy Cytopathology. Acta Cytol 2019; 63:255-256. [PMID: 31137023 DOI: 10.1159/000501055] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Andrew S Field
- University of NSW and University of Notre Dame Medical Schools, and Department of Anatomical Pathology, St Vincent's Hospital, 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
| | - Fernando C Schmitt
- Institute of Molecular Pathology and Immunology of Porto University (IPATIMUP), Instituto de Investigação e Inovação em Saúde and Medical Faculty, University of Porto, Porto, Portugal
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