Comparison of the Accuracy of Breast Cytological Diagnosis at Seven Institutions in Southern Fukuoka Prefecture, Japan

Abstract

Objective: Cytological examination is inexpensive and relatively simple to carry out and deserves utilization in breast cancer screening. We investigated the status of cytological diagnosis at seven facilities in southern Fukuoka Prefecture, Japan. Methods: We collected data on the criteria for cytological judgments and status of breast cytological diagnosis at seven different facilities in this region. Results: Among 5693 individuals who underwent breast cytological examination, analyses were conducted on 1250 individuals (22.0%) in whom cytological diagnoses were confirmed by histological diagnoses. Among these patients, cytological diagnosis had an absolute sensitivity of 71.9%, a specificity of 76.0%, a false-negative value of 6.7% and a false-positive value of 0.08%. At three facilities with relatively large numbers of cases (.300), excluding a facility for specialized breast disease, similar trends of high complete sensitivity (94.3, 95.6 and 97.1%, respectively) and low absolute sensitivity (60.4, 74.8 and 57.2%, respectively) were found. No false-negative or false-positive cases were seen in individual facilities with relatively low numbers of cases (,150). Conclusions: The accuracy of cytological diagnosis at the facilities we surveyed was relatively high compared with the goals of assessment of diagnostic accuracy. However, the performance was dependent on the facility type, i.e. number of cases, staff involved and whether it was specialized or not, making the diagnosis specific for this region. We recommend that management of the accuracy of cytological diagnosis be undertaken jointly by multiple facilities to establish systems in Japan that lead to more useful diagnostic tools.

Fine-Needle Aspiration Cytology Can Play a Role in Neoadjuvant Chemotherapy in Operable Breast Cancer

“…A recent Japanese study [17] of 5693 FNAC and 7 different laboratories illustrated a great variability between the institutions suggesting likely difference between education of cytologists and the lack of clinical or radiological information (triple diagnosis).…”

Evaluation of inadequate, indeterminate, false-negative and false-positive cases in cytological examination for breast cancer according to histological type

“…Therefore, improving the accuracy of FNAB is an important issue, even though we showed that the accuracy of FNAB is as high as that recommended under the relevant clinical guidelines [5]. We believe that there is room for improvement.…”

“…Therefore, the present findings should encourage the use of needle biopsy rather than aspiration when this histological type is suspected based on imaging. Furthermore, triple assessment (i.e., clinical, pathological and radiological assessment) should be considered in some cases [5,19]. It is also important that staff receive appropriate pathological and clinical training, and that there is good communication between clinicians and pathological staff [5].…”

“…The diagnosis was established histologically in 1250 (22.0%) of these cases, which formed the basis for determining the diagnostic accuracy in our previous report [5]. Inadequate and indeterminate cases based on cytological examinations were confirmed by histological findings, and any cases with discrepancies between the cytological and histological diagnosis (i.e., false-negative and false-positive cases) were analyzed.…”

“…In such circumstances, we recently reported the accuracy of cytological diagnosis compared with histological diagnosis of breast disease in institutes in our area of southern Fukuoka Prefecture, Japan [5]. We found that the accuracy of cytological diagnosis at these institutes was equivalent to that recommended for diagnostic accuracy in Japanese [4] and UK [6,7] guidelines.…”