The role of the IAC Yokohama System for Reporting Breast Fine Needle Aspiration Biopsy and the ACR Breast Imaging‐Reporting and Data System in the evaluation of breast lesions

Abstract

Background Stratification of breast lesions for appropriate management is achieved through an integration of clinical examination, imaging, and fine needle aspiration biopsy (FNAB). The current study aimed to evaluate the combined effectiveness of the widely used Breast Imaging‐Reporting and Data System (BI‐RADS) with the recently proposed International Academy of Cytology (IAC) Yokohama System for Reporting Breast Fine Needle Aspiration Biopsy Cytopathology. Methods A retrospective analysis was done on all breast FNABs from 2016 through 2020. The cases were categorised according to the IAC Yokohama System. Histopathological correlation of the BI‐RADS and IAC Yokohama System was performed. The rate of malignancy (ROM) for each category of the BI‐RADS and IAC Yokohama System was calculated. Results The ROM values for categories I to V were 38%, 0.6%, 21.9%, 100%, and 97%, respectively. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of FNAB with category III assumed as malignant were 98.9%, 85%, 76.1%, 99.3%, and 89.5%, respectively. With category III assumed as benign, these indices were 90.8%, 98.9%, 97.5%, 95.7%, and 96.2%, respectively. The sensitivity, specificity, PPV, NPV and accuracy of BI‐RADS were 91.5%, 81.9%, 72%, 95%, and 85.1%, respectively. Conclusions FNAB is still an indispensable test in the evaluation of breast lesions. The utilisation of the IAC Yokohama reporting system for breast cytology in conjunction with ACR BI‐RADS aids in better stratification of lesions.

Insufficient/inadequate category in breast cytology: Are the standardized guidelines of rapid on‐site evaluation available to reduce its rate?

“…These studies report ROM in the different categories of IACYS. The ROM was ranged in categories II 0.4% to 8.3%, III 1.3% to 50%, IV 55.55% to 100%, and V 97% to 100% 4–18 . The ROM in category I without ROSE ranges from 0% to 60.87% 4–18 and 0% to 11.11% 8,17 with ROSE.…”

“…The ROM was ranged in categories II 0.4% to 8.3%, III 1.3% to 50%, IV 55.55% to 100%, and V 97% to 100% 4–18 . The ROM in category I without ROSE ranges from 0% to 60.87% 4–18 and 0% to 11.11% 8,17 with ROSE. Wong et al (2019) and Wong et al (2021) observed a statistically significant difference in category 1 and category 5 when FNAB with ROSE compared with FNAB without ROSE 17 .…”

“…The ROM was ranged in categories II 0.4% to 8.3%, III 1.3% to 50%, IV 55.55% to 100%, and V 97% to 100%. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] The ROM in category I without ROSE ranges from 0% to 60.87% [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] and 0% to 11.11% 17 The IACYS has also endorsed the use of ROSE whenever possible to reduce the rate of insufficient/inadequate FNAB. 19 The many advantages of ROSE in overall cytology are described in the literature.…”

Assessing the accuracy of the International Academy of Cytology Yokohama System for reporting breast fine needle aspiration biopsy cytology at a Vietnamese oncology centre

“…In a College of American Pathologists survey, only 16.8% (82 of 488) were aware of the IAC Yokohama System 13 . Through their retrospective analysis, Sundar et al 14 concluded that the combination of the findings of the Breast Imaging‐Reporting and Data System (BI‐RADS) with the IAC Yokohama System may yield the best results for the proper stratification of breast lesions. However, substantial evidence in support of how to best use the classification systems is lacking in the literature.…”