Diagnostic Performance of Ultrasound-Guided Fine-Needle Aspiration of Nonpalpable Breast Lesions in a Multidisciplinary Setting

Roca, Josep A. Farras; Tardivon, A.; Thibault, Fabienne; Khoury, C. El; Alran, S.; Fourchotte, Virginie; Marck, Véronique; Alepee, B; Sigal, Birigitte; Rycke, Yann De; Rouzier, Roman; Klijanienko, Jerzy

doi:10.1093/ajcp/aqx009

Cited by 30 publications

(39 citation statements)

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“…In the total of 579 lesions with matched FNAB and histopathological results, the percentage of cases in each cytological category were: “insufficient” 6.7%, “benign” 29.9%, “atypical” 19.9%, “suspicious of malignancy” 9% and “malignant” 34.5% (Table 3). These overall percentages are in keeping with the findings of other recent studies [3, 4, 18]. However, they do not reflect the true number of “benign” diagnoses, since the majority of the 1,937 “benign” cases among the total of 2,696 breast FNAB (that is, 72% of all FNAB) did not undergo CNB or excision biopsy, but rather were followed clinically based on the “triple test” result.…”

Section: Discussionsupporting

confidence: 81%

“…There were minor decreases in “atypical” and “suspicious of malignancy.” ROSE clearly reduces the “insufficient” rate, which is traditionally viewed as its major role at FNAB [4], but it also increases the “malignant” rate and to a lesser extent reduces the indeterminate “atypical” and “suspicious of malignancy” categories making the FNAB more efficient in making “benign” and particularly “malignant” diagnoses (Tables 1-3). This is further demonstrated in Tables 4 and 5, where the provisional diagnosis at ROSE and the final diagnosis are tabulated against the histopathological outcome, and Table 5 can be compared to Table 6.…”

Section: Discussionmentioning

confidence: 99%

“…Fine needle aspiration biopsy (FNAB) cytology is a rapid, minimally invasive, accurate, cost effective biopsy technique in the breast that is well accepted by patients and that has a long history of successful utilization for both palpable and impalpable lesions using ultrasound guidance [1-4]. The development of core needle biopsy (CNB) initially for the assessment of calcifications and lesions detected by mammography has challenged and in some cases replaced FNAB [5, 6].…”

Section: Introductionmentioning

confidence: 99%

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The International Academy of Cytology Yokohama System for Reporting Breast Fine Needle Aspiration Biopsy Cytopathology: A Single Institutional Retrospective Study of the Application of the System Categories and the Impact of Rapid Onsite Evaluation

et al. 2019

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Objectives: To review the performance and utility of the International Academy of Cytology (IAC) Yokohama System for Reporting Breast Fine Needle Aspiration Biopsy (FNAB) Cytology five category stratification and evaluate the impact of rapid onsite evaluation (ROSE). Method: A retrospective analysis of breast FNAB cytology cases with matched histopathological results at a single institution over a 32 months period using a structured reporting system with 5 diagnostic categories (“inadequate/insufficient,” “benign,” “atypical,” “suspicious of malignancy” and “malignant”) closely paralleling the proposed IAC System. Results: Of 2,696 breast FNAB cases, there were 579 with matched histopathology and 456 of these had ROSE. ROSE decreased the number in the “insufficient” category (17.1% without ROSE to 4.0% with ROSE) and increased the number in the “malignant” (17.9 to 39.0%) with a lesser impact on the “atypical,” “benign” and “suspicious of malignancy” categories. The performance data showed a positive predictive value of 96.4%, negative predictive value of 97.6%, and a risk of malignancy of a FNAB categorized as “insufficient” to be 2.6%, “benign” 1.7%, “atypical” 15.7%, “suspicious of malignancy” 84.6%, and “malignant” 99.5%. Conclusion: Breast FNAB is an accurate test enabling effective diagnosis of breast lesions. ROSE improved the performance by decreasing the proportion of “insufficient” and “atypical” and increasing the “suspicious of malignancy” and “malignant” diagnoses and enabling immediate triage for further biopsy where necessary.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The International Academy of Cytology Yokohama System for Reporting Breast Fine Needle Aspiration Biopsy Cytopathology: A Single Institutional Retrospective Study of the Application of the System Categories and the Impact of Rapid Onsite Evaluation

et al. 2019

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“…The definition and use of the term “suspicious of malignancy” varies in similar fashion to the term “atypical” and this is reflected in the published range of PPV of a suspicious diagnosis from 60 to 95% [3-6, 8, 12, 14, 15, 70-78]. Two recent studies utilizing the IAC Yokohama System had ROM for a “suspicious of malignancy” diagnosis of 97.1 and 84.6% [16, 17].…”

Section: Category: Suspicious Of Malignancymentioning

confidence: 99%

“…The PPV of a malignant breast FNAB ideally should be 100%, but there is a reported range from 92 to 100% [3-6, 8, 12, 14, 15, 70-78]. Two recent studies utilizing the IAC Yokohama Reporting System had ROM of 100 and 99.0% for the malignant category [16, 17].…”

Section: Category: Malignantmentioning

confidence: 99%

The International Academy of Cytology Yokohama System for Reporting Breast Fine-Needle Aspiration Biopsy Cytopathology

et al. 2019

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The International Academy of Cytology (IAC) gathered together a group of cytopathologists expert in breast cytology who, working with clinicians expert in breast diagnostics and management, have developed the IAC Yokohama System for Reporting Breast Fine-Needle Aspiration Biopsy (FNAB) Cytology. The project was initiated with the first cytopathology group meeting in Yokohama at the 2016 International Congress of Cytology. This IAC Yokohama System defines five categories for reporting breast cytology, each with a clear descriptive term for the category, a definition, a risk of malignancy (ROM) and a suggested management algorithm. The key diagnostic cytopathology features of each of the lesions within each category will be presented more fully in a subsequent atlas. The System emphasizes that the crucial requirements for diagnostic breast FNAB cytology are a high standard for the performance of the FNAB and for the making of direct smears, and well-trained experienced cytopathologists to interpret the material. The performance indicators of breast FNAB, including specificity and sensitivity, negative predictive value, positive predictive value and ROM stated in this article have been derived from the recent literature. The current practice of breast FNAB has evolved with the increasing use of ultrasound guidance and rapid on-site evaluation. Two recent publications have shown a range of ROM for the insufficient/inadequate category of 2.6–4.8%, benign 1.4–2.3%, atypical 13–15.7%, suspicious of malignancy 84.6–97.1%, and malignant 99.0–100%. The management algorithm in the System provides options because there are variations in the management of breast lesions using FNAB and core-needle biopsy in those countries utilizing the “triple test” of clinical, imaging, and FNAB assessment, and also variations in the availability of CNB and imaging in low- and middle-income countries. The System will stimulate further discussion and research, particularly in the cytological diagnostic features of specific lesions within each category and in management recommendations. This will lead to continuing improvements in the care of patients with breast lesions and possible modifications to the IAC Yokohama System.

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Sanchez

Burga

Ljung

2017

Cancer Cytopathology

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For many decades, basic principles of surgical oncology have advised against manipulation of tumors to prevent local and systemic spread of cancer cells. McGuirt and McCabe demonstrated that open biopsy of metastatic cancer in the neck before definitive treatment increased the risk of both local recurrence and distant metastasis. 1 Furthermore, Roussel and colleagues conducted a meta-analysis focused on intra-abdominal and intrathoracic lesions and calculated that increasing the diameter of the needle by a factor of 2 increased the risk of tumor implantation by a factor of 60. 2 Experimental studies have demonstrated such an event in animal models. 3 Fine-needle aspiration biopsy (FNAB) was used fairly extensively for diagnosis of breast lesions during the 1970s, 1980s, and 1990s. Since then, core-needle biopsy (CNB) has been widely adopted. The reasons are multiple. Two main motivators were the often high nondiagnostic rates as well as concerns about falsenegative and false-positive diagnoses. This was mainly because of the lack of adequate training in specimen procurement. FNAB was perceived as a simple and easy to perform procedure requiring only readily available, simple tools and minimal training. Studies have indicated that there is wide variability in the accuracy of breast FNAB 4 and that the main impetus for accuracy is specimen quality. 5 In addition, interpretation of FNAB specimens is different from interpretation of histologic specimens and requires specific training. 6 Pathologists without adequate training in FNAB interpretation may be inclined to report excessive numbers of cases as "atypical," significantly reducing the usefulness of the FNAB procedure. An additional concern is the need to assess hormone receptor and human epidermal growth factor receptor status in patients with cancer. A recent study demonstrates that FNAB-generated cell blocks serve as a reliable substrate for such testing. 7 A shift in practice driven by mammography screening and increased use of other breast imaging modalities has transitioned the sampling of breast lesions to radiologists who routinely use imaging guidance, even when targeting palpable lesions. CNB and Mammotome procedures (Devicor Medical Products, Inc., Leica Biosystems, Buffalo Grove, IL) have been widely marketed to radiologists, and reimbursement is significantly higher than for FNAB. However, there are institutions that have maintained FNAB as part of the armamentarium of breast cancer diagnosis. 8 In this issue of Cancer Cytopathology, Sennerstam and colleagues 9 report how FNAB is associated with a lower rate of distant metastases than CNB in a comparison between 2 rigorously matched cohorts. The difference in the physics of tumor disruption between the 2 procedures, combined with the difference in needle diameter, provides a rational explanation for this result. Therefore, if we accept that the samples obtained from each of these modalities are on par, given adequate training in both procurement and interpretation, then

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Diagnostic Performance of Ultrasound-Guided Fine-Needle Aspiration of Nonpalpable Breast Lesions in a Multidisciplinary Setting

Abstract: USFNA is a robust diagnostic procedure in NPBLs. Age and the BI-RADS category of the lesion are important factors determining its performance.

Cited by 30 publications

References 38 publications

The International Academy of Cytology Yokohama System for Reporting Breast Fine Needle Aspiration Biopsy Cytopathology: A Single Institutional Retrospective Study of the Application of the System Categories and the Impact of Rapid Onsite Evaluation

The International Academy of Cytology Yokohama System for Reporting Breast Fine Needle Aspiration Biopsy Cytopathology: A Single Institutional Retrospective Study of the Application of the System Categories and the Impact of Rapid Onsite Evaluation

The International Academy of Cytology Yokohama System for Reporting Breast Fine-Needle Aspiration Biopsy Cytopathology

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