Diagnostic Value of Fine Needle Aspiration Cytology for Breast Tumors

Mišković, Josip; Zorić, Andrea; Mišković, Helena Radić; Šoljić, Violeta

doi:10.20471/acc.2016.55.04.13

Cited by 18 publications

(19 citation statements)

References 29 publications

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“…If any two of the three triple test parameters are discordant, patients should undergo excisional biopsy for further histopathological evaluation . In resource‐limited healthcare settings, breast ultrasound paired with FNAC, as an alternative to breast mammography with CNB, can provide patients with substantial cost savings without compromising diagnostic accuracy . Reduction of monetary barriers to diagnosis and treatment is critical for patients in developing nations, such as Kenya, where universal healthcare is only just being introduced and healthcare costs are still largely covered by patient out‐of‐pocket payments for services rendered…”

Section: Discussionmentioning

confidence: 99%

Concordance of breast fine needle aspiration cytology interpretation with subsequent surgical pathology: An 18‐year review from a single sub‐Saharan African institution

2019

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Introduction:There are many merits to fine needle aspiration cytology (FNAC) in evaluation of palpable breast lesions. We set out to determine the concordance of breast FNAC interpretation with subsequent surgical pathology in the resource-limited healthcare setting of rural Kenya.Methods: African Inland Church Kijabe Hospital electronic pathology files were retrospectively reviewed from 1/1999-9/2017. All breast FNAC cases and subsequent surgical pathology specimens were identified. FNAC interpretations were categorised according to the International Academy of Cytology Yokohama codes: insufficient; benign; atypical favour benign; suspicious favour malignant; and malignant.Surgical pathology results were categorised as benign or malignant. Results:In total, 695 breast FNACs were identified. A total of 219 (31.5%) had subsequent surgical pathology. Average patient age was 39 years (range 13-88); 95% were female. Nearly all (98%) lesions were palpable. FNAC interpretive categorisation was as follows: 20 (9%) insufficient, 103 (47%) benign, 16 (7%) atypical, 24 (11%) suspicious and 56 (26%) malignant. On histopathology, there were 141 (64%) benign cases and 78 (36%) malignancies (Table 1). The sensitivity of FNAC for detecting malignancy was 85%; specificity was 75%. Positive and negative predictive values were 69% and 88%. Diagnostic concordance between FNAC and histopathology was 79%.For definitively diagnostic FNAC categories, diagnostic concordance was 89%. On histopathology, malignant diagnoses were given in 0 insufficient, 12 (12%) benign, 4 (25%) atypical, 11 (46%) suspicious and 51 (91%) malignant cases. There were five false-positive cytopathology interpretations and 12 false-negatives.Conclusions: FNAC remains a valuable tool in evaluation of palpable breast lesions in resource-limited healthcare settings. K E Y W O R D SAfrica, breast, cytology, fine needle aspiration, Kenya

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Section: Discussionmentioning

confidence: 99%

Concordance of breast fine needle aspiration cytology interpretation with subsequent surgical pathology: An 18‐year review from a single sub‐Saharan African institution

2019

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“…In previous studies on HBC, the diagnostic accuracy of FNAC in the evaluation of breast lesions compared with histopathology ranged from 90.1% to 95.1%; sensitivity varied from 93.8% to 97.7%, and specificity varied from 80.8% to 100% [ 31 – 33 ]. In CMTs reports, diagnostic agreement of cytological examination for differentiating malignant and benign lesions varied from 63% [ 34 ] to 81.4% [ 8 ], sensitivity ranged from 25% [ 21 ] to 95.23% [ 5 ], and specificity from 49% [ 21 ] to 96% [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic efficacy of smear cytology and Robinson’s cytological grading of canine mammary tumors with respect to histopathology, cytomorphometry, metastases and overall survival

et al. 2018

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Cytology is a simple, rapid, and inexpensive method used for pre-operative diagnosis of canine mammary tumors (CMTs) in veterinary practice. Studies related to human breast cancer showed the Robinson’s grading system—established for invasive ductal carcinoma, not otherwise specified (IDC, NOS) and used on cytological material—to not only closely correspond to the histopathological grading but also be helpful in assessing prognosis and selecting most suitable treatments before surgery. The objectives of this study were: to evaluate the accuracy of cytological diagnosis and cytological Robinson’s grading system compared to the histopathological examination of CMTs; to compare of cytological features and cytomorphometric parameters with tumor behavior, as well as cytological and histological grading; and to determine an association of the Robinson’s grading system and cytological background details with metastases, and patients’ survival. We report substantial diagnostic accuracy in detecting simple types and high grade tumors. Cytological diagnosis of tumor behavior showed relatively low sensitivity and specificity compared to human studies, and this might be caused by the heterogeneous morphology of CMTs. The presence of mucosecretory material and extracellular matrix was not significantly associated with tumor behavior. We report a positive correlation between both grading systems and cytological features (included in Robinson’s grading), the presence of necrotic debris, inflammation, and red blood cells. A negative correlation was determined only for the presence of extracellular matrix. The univariate and multivariate analyses confirmed a significantly higher risk of developing metastasis and shorter overall survival for dogs with tumors of grade 2 or 3 on cytology. In addition, these tumors were the most common cause of CMT-related deaths in dogs. Taken together, our findings suggest that the Robinson’s method of cytological grading applied for malignant CMTs evaluated in cytological smears regardless of tumor type can be adapted to veterinary cytology. Additionally, some background features seem to aid malignancy assessment.

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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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Diagnostic Value of Fine Needle Aspiration Cytology for Breast Tumors

Cited by 18 publications

References 29 publications

Concordance of breast fine needle aspiration cytology interpretation with subsequent surgical pathology: An 18‐year review from a single sub‐Saharan African institution

Concordance of breast fine needle aspiration cytology interpretation with subsequent surgical pathology: An 18‐year review from a single sub‐Saharan African institution

Diagnostic efficacy of smear cytology and Robinson’s cytological grading of canine mammary tumors with respect to histopathology, cytomorphometry, metastases and overall survival

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

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