Combined use of imaging and cytologic grading schemes for screen-detected breast abnormalities improves overall diagnostic accuracy

Farshid, Gelareh; Downey, Peter

doi:10.1002/cncr.21280

Cited by 12 publications

(13 citation statements)

References 27 publications

(40 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This is even lower than the 8.7% rate of inadequacy for the entire group of lesions (Farshid and Downey, 2005). The high rates of inadequate samples of FNAB, ranging up to 58.7% in some reports has contributed to discouraging the use of this technique (Ibrahim et al, 2001).…”

Section: Discussionmentioning

confidence: 93%

“…This approach thus obviates the need for further, more invasive investigations in 76.8% of clients. The PPV of cytology for this group of lesions is also high, but at 95.2%, it is not sufficiently reliable for definitive surgical management (Farshid and Downey, 2005). Our current protocols therefore require confirmation of malignancy by core biopsy in category 3 masses with positive cytology.…”

Section: Discussionmentioning

confidence: 95%

“…In experienced hands and for appropriately selected lesions this test is clinically useful and reliable (Farshid and Downey, 2005). In our programme we use FNAB as a first line diagnostic modality for the assessment of category 3 mass lesions, supplemented where necessary, by core biopsy and surgical biopsy.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Assessment of 1183 screen-detected, category 3B, circumscribed masses by cytology and core biopsy with long-term follow up data

et al. 2008

View full text Add to dashboard Cite

Discrete masses are commonly detected during mammographic screening and most such lesions are benign. For lesions without pathognomonically benign imaging features that are still regarded likely to be non-malignant (Tabar grade 3) reliable biopsy results would be a clinically useful alternative to mammographic surveillance. Appropriate institutional guidelines for ethical research were followed. Between Jan 1996 -Dec 2005 grade 3B discrete masses detected in the setting of a large, population based, breast cancer screening programme are included. Patient demographics, fine needle aspiration biopsy (FNAB), core and surgical biopsy results are tabulated. The final pathology of excised lesions was obtained. Information regarding interval cancers was obtained from the State Cancer Registry records and also through long term follow-up of clients in subsequent rounds of screening. A total of 1183 lesions, mean diameter of 13.3 mm ( ± 8.3 mm) and mean client age of 55.1 years ( ± 8.8 years) are included. After diagnostic work up, 98 lesions (8.3%) were malignant, 1083 were non-malignant and a final histologic diagnosis was not established in two lesions. In the 27 months after assessment, no interval cancers were attributable to these lesions and during a mean follow up of 54.5 months, available in 84.9% of eligible women, only one cancer has developed in the same quadrant as the original lesion, although the two processes are believed to be unrelated. FNAB performed in 1149 cases was definitive in 80.5% cases (882 benign, 43 malignant) with a negative predictive value (NPV) of 99.8% (880 of 882) and a positive predictive value (PPV) of 95.2% (40 of 42, both intraductal papillomas). Core biopsy was performed in 178 lesions, mostly for indefinite cytology. Core biopsy was definitive in 79.8% cases (57% benign 22% malignant) with a PPV of 100% and NPV of 99.0%. In experienced hands FNAB is an accurate first line diagnostic modality for the assessment of 3B screen-detected discrete masses, providing definitive results in 80.5% of cases. When used as a second line modality, core biopsy had a similarly high rate of definitive diagnosis at 79.8%. The stepwise approach to the use of FNAB and core biopsy would reduce substantially the proportion of cases requiring surgical diagnostic biopsy. Given the low probability of malignancy and the imperative to limit the morbidity associated with cancer screening, the demonstration of the reliability of FNAB as a minimally invasive but highly accurate test for this particular subset of screen-detected lesions has significant clinical utility.

show abstract

Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 95%

See 1 more Smart Citation

Assessment of 1183 screen-detected, category 3B, circumscribed masses by cytology and core biopsy with long-term follow up data

et al. 2008

View full text Add to dashboard Cite

show abstract

“…However, radiological findings can bias cytology results if too much emphasis is placed on the radiological findings as most C3 cases are associated with R3 or R4. Relying too much on radiology in these circumstances is therefore not very helpful [28,29]. …”

Section: Discussionmentioning

confidence: 99%

“…On review, these were easily categorized as C4. The benign clinical impression is therefore more than likely to have influenced the categorization of these cases as C3 rather than C4 or C5 [29]. …”

Section: Discussionmentioning

confidence: 99%

The True Nature of Atypical Breast Cytology

Weigner

Zardawi²,

Braye³

2013

Acta Cytologica

View full text Add to dashboard Cite

Background: Atypical breast cytology is a poorly understood heterogeneous category with limited clinical utility but significant implications for patient management. Objective: To provide an insight into the true nature of atypical breast cytology in screening-detected (asymptomatic) and symptomatic settings, and find strategies for reducing the use of this diagnostic category. Materials and Methods: A total of 6,415 breast cytology samples were processed between January 2004 and December 2008. An atypical cytological diagnosis was rendered in 256 (4%) of the cases. A blind microscopic review of the atypical cases was conducted and results were correlated with subsequent histological and/or clinical outcomes. Results: Follow-up information by histology was available in 85.5%, by repeat fine-needle aspiration (FNA) in 3.5% and by imaging or clinical follow-up in 10.2% of the cases. Two patients (0.8%) were lost to follow-up. Of the 254 cases with follow-up, 62.6% were benign and 37.4% were malignant. The benign to malignant ratios were 1:1 and 2:1 in the screening and symptomatic groups, respectively. The atypical category in the screening population mostly yielded fat necrosis, complex sclerosing lesions and low- to intermediate-grade carcinoma on follow-up. The main outcomes in the symptomatic group were papilloma, fibroadenoma, ductal carcinoma in situ and lobular carcinoma. Preanalytical (suboptimal samples) factors were encountered in 34.8% and interpretative factors in 65.2% of the cases. Uncertainty about cellular morphology was attributed to such a diagnosis in 38 (14.8%) of the cases, architectural complexity in 137 (53.5%) and morphology and architecture in 70 (27.3%); 4.3% of cases were considered nondiagnostic. Conclusion: The atypical category is a necessary diagnosis but of limited use from a patient management perspective. Some preanalytical factors such as poor sample quality can be minimized by the involvement of cytopathologists in the FNA procedure. The use of the atypical category is partly dependent on the experience and confidence of the reporting pathologist. Assigning a case to this category is also likely to be unduly influenced by clinical or radiological findings. Our study indicates that the use of the atypical category can be reduced by up to 40% by appreciating these contributing factors. The practical utilization of the atypical category in breast cytology remains subjective and further study is required to identify useful objective criteria.

show abstract

Cancer size, histotype, and cellular grade may limit the success of fine‐needle aspiration cytology for screen‐detected breast carcinoma

Manfrin

Falsirollo²,

Remo³

et al. 2009

Cancer Cytopathology

View full text Add to dashboard Cite

Mutations or deletions involving ZFHX1B (previously SIP1) have recently been found to cause one form of syndromic Hirschsprung disease (HSCR), associated with microcephaly, mental retardation, and distinctive facial features. Patients with the characteristic facial phenotype and severe mental retardation, but without HSCR, have now also been shown to have mutations in this gene. Mutations of ZFHX1B are frequently associated with other congenital anomalies, including congenital heart disease, hypospadias, renal tract anomalies, and agenesis of the corpus callosum (ACC). We present the clinical data and mutation analysis results from a series of 23 patients with this clinical syndrome, of whom 21 have proven ZFHX1B mutations or deletions (15 previously unpublished). Two patients with the typical features (one with and one without HSCR) did not have detectable abnormalities of ZFHX1B. We emphasize that this syndrome can be recognized by the facial phenotype in the absence of either HSCR or other congenital anomalies, and needs to be considered in the differential diagnosis of dysmorphism with severe mental retardation +/− epilepsy. © 2003 Wiley‐Liss, Inc.

show abstract

Combined use of imaging and cytologic grading schemes for screen-detected breast abnormalities improves overall diagnostic accuracy

Cited by 12 publications

References 27 publications

Assessment of 1183 screen-detected, category 3B, circumscribed masses by cytology and core biopsy with long-term follow up data

Assessment of 1183 screen-detected, category 3B, circumscribed masses by cytology and core biopsy with long-term follow up data

The True Nature of Atypical Breast Cytology

Cancer size, histotype, and cellular grade may limit the success of fine‐needle aspiration cytology for screen‐detected breast carcinoma

Contact Info

Product

Resources

About