Analysis of morphologic patterns of fine-needle aspiration of the breast to reduce false-negative results in breast cytology

Bulgaresi, Paolo; Cariaggi, Maria Paola; Bonardi, L; Carozzi, Maria Francesca; Confortini, Massimo; Galanti, Laura; Maddau, Cristina; Matucci, Marzia; Rubeca, Tiziana; Turco, P. H. N.; Ciatto, Stefano; Miccinesi, Guido

doi:10.1002/cncr.21059

Cited by 15 publications

(17 citation statements)

References 7 publications

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“…Bulgaresi et al [27 ]also reported an association between the lack of apocrine cells and cancer; however, they did not attain a statistically significant association. This criterion and the background features such as the presence of bare bipolar nuclei and cystic change are indicative of a benign pathology and should be considered within the clinical context.…”

Section: Discussionmentioning

confidence: 99%

The Microscopic Complexities of C3 in Breast Cytology

Weigner

Zardawi²,

Braye³

et al. 2014

Acta Cytologica

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Background: Fine-needle aspiration (FNA) of difficult breast lesions often results in an atypical (C3) report. The assortment of outcomes generated by C3 reports varies widely, and this has given rise to different clinical management pathways. Objective: To identify and objectively assess microscopic features associated with atypical/C3 breast FNA cases. Materials and Methods: A total of 230 atypical breast FNAs were subjected to a blind microscopic rescreen using a range of robust qualitative and quantitative cytological criteria including cellularity, architectural qualities, cytomorphology and background features. A logistic regression with a receiver operating characteristic (ROC) curve and the resultant forward stepwise analysis were conducted to assess the results. This statistical testing was measured against malignant, benign proliferative and benign non-proliferative outcomes. Results: The malignant and benign proliferative outcomes showed a mixture of opposing protective and predictive individual cytological criteria. The stepwise analysis produced models demonstrating the best combination of individual cytological criteria for malignancy, proliferative and benign non-proliferative entities. In the malignancy model, discohesion, nuclear crowding within sheets, diminished numbers of bare bipolar nuclei and myoepithelial cells, the presence of tubules or necrosis and the absence of a cystic background were important features. The benign proliferative model suggested the same criteria but with the opposite implication and with the addition of several others, such as the presence of apocrine metaplasia, retained polarity and a speckled or coarse chromatin pattern. Age was a significant factor in malignant and proliferative outcomes. The benign non-proliferative stepwise analysis produced a model with fewer criteria (complex sheets, bare bipolar nuclei and a cystic background) limiting clinical application. Conclusion: Atypical/C3 breast cytology remains a legitimate reporting category. However, it is associated with a number of different histological outcomes. The incidence of the C3 category can be significantly reduced by controlling extrinsic factors and understanding the associated microscopic features.

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Section: Discussionmentioning

confidence: 99%

The Microscopic Complexities of C3 in Breast Cytology

Weigner

Zardawi²,

Braye³

et al. 2014

Acta Cytologica

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“…sampling error (non in this series) as well as misinterpretation of the findings, i.e. misdiagnosis 7,8 (two in this series). The cytological features in such FN cases 'like those seen in the second case in particular' usually show either a predominant benign cellular yield or mixed benign /malignant picture.…”

Section: Discussionmentioning

confidence: 75%

“…5,6 The overall FN rate in our study was 0.67% and it is generally less than 5% in most reported studies. 7,8 The two true FN cases were in the benign (C2) category. One case was diagnosed by FNAB as cellular fibroadenoma with minimal cytoarchitectural atypia in an elderly woman that turned to be a small, low-grade phyllodes tumor on histological examination.…”

Section: Discussionmentioning

confidence: 99%

“…In rare cases, technical errors can interfere with the overall interpretation, such as forceful smearing artifact resulting in cellular disruption (pseudo dyscohesiveness) or partial air-drying with an associated pleomorphic relatively larger cells. 7,8 Our experience showed that to allow recognition of these FN cases in the future, careful attentions must be paid to the nuclear details, the pattern of monomorphism, the subtle cellular dyscohesiveness and not to oversight the presence or absence of the bipolar cells in the background. In addition, constant correlation between cytology and histology is also essential.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, constant correlation between cytology and histology is also essential. 7,8 The four FP diagnoses in our series were all categorized as [C2] and included; one fibroadenoma with apocrine metaoplasia in a 46-year-old woman, one florid ductal hyperplasia with a radiological fibroadenosis picture but with atypical features; the other two cases were fibrocystic change with atypical pleomorphic epithelial cells. It has been found that most common causes of FP cytologic diagnosis reported in the literature are fibroadenoma and ductal hyperplasia, and that was clearly consistent with our results in this study.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy of fine‐needle aspiration biopsy in diagnosis of breast cancer: A retrospective study of 303 cases in Bahrain

Al-Sindi¹,

Kamal²,

Golbahar

2009

Diagnostic Cytopathology

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Breast cancer is a leading cause of death in many countries worldwide and breast lesions remain a common diagnostic dilemma. Fine-needle aspiration biopsy (FNAB) has been suggested as the most important, first line, minimally invasive measure in the management of patients with breast lesions. The aim of this study is to evaluate the efficacy of FNAB in patients with breast lesions by comparing the diagnostic accuracy of cytology results with that of the definitive histological examination outcome and also to investigate the added value of a single aspirator experience to the overall diagnostic precision and compared with the internationally published results. A retrospective study of 303 breast FNAB samples were carried out by a single experienced cytopathologist with complete comparison records.The prevalence of positive cytologic diagnosis for the breast cancer was determined to be 20.4%. The overall diagnostic accuracy of FNAB was 97.9%, with a specificity and sensitivity of 98.3 and 96.5%, respectively. The overall positive and negative predictive values were determined to be 93.2 and 99.2%, respectively. In addition, the sensitivity was comparable in cases that have been attempted by palpation-guided sampling compared with those aspirations that were carried out under US guidance.Results from this study confirm that FNAB biopsies performed and reported by a dedicated, single, skilled cytopathologist are highly effective in diagnosis of breast lesions and reliable in differentiating benign and malignant breast lesions with an overall high efficacy in a specialized laboratory-based FNAB clinic.

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The International Academy of Cytology Yokohama System for Reporting Breast Cytopathology showed improved diagnostic accuracy

Marabi

Aphivatanasiri

Jamidi³

et al. 2021

Cancer Cytopathology

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BACKGROUND:The aim of the International Academy of Cytology Yokohama System for Reporting Breast Fine Needle Aspiration Biopsy Cytopathology is to improve cytology practice. This study assessed cytologic diagnoses made with the system and its efficacy when it was applied by pathologists with different levels of experience. METHODS: In all, 1080 cases of breast fine-needle aspiration biopsy (FNAB) over a period of 16 years were reviewed and reclassified with the system. The category distribution and the diagnostic performance were compared with the original diagnoses. The concordance rates for diagnoses from pathologists with different levels of experience were also determined. RESULTS: The distribution of cytologic diagnoses made with the system was as follows: 11.7% were insufficient, 56.6% were benign, 20.1% were atypical, 6.1% were suspicious for malignancy, and 5.6% were malignant. The rates for the insufficient and atypical categories were lower than the original diagnosis rates (13.1% and 23.8%, respectively). Overall, 120 cases (11.1%) were recategorized. Among those recategorized as benign, suspicious, or malignant with follow-up data, 96.7% were correctly reclassified. A significant improvement in diagnostic performance was found with the system (P < .001). Such improvement was also seen in problematic breast lesions, including fibroepithelial lesions, papillary lesions, and low-grade carcinomas. Pathologists with intermediate experience showed a higher concordance with an expert pathologist in the diagnoses than those with short experience (κ, 0.838 vs 0.634). CONCLUSIONS:The system effectively categorized the diagnoses, and the diagnostic performance of FNAB reporting was improved. The structured reporting also enhanced the reproducibility of reporting by pathologists with intermediate experience and, to some extent, those with short experience.

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Analysis of morphologic patterns of fine-needle aspiration of the breast to reduce false-negative results in breast cytology

Cited by 15 publications

References 7 publications

The Microscopic Complexities of C3 in Breast Cytology

The Microscopic Complexities of C3 in Breast Cytology

Efficacy of fine‐needle aspiration biopsy in diagnosis of breast cancer: A retrospective study of 303 cases in Bahrain

The International Academy of Cytology Yokohama System for Reporting Breast Cytopathology showed improved diagnostic accuracy

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