Atypical aspirates of the breast: a dilemma in current cytology practice

Yu, Shuangni; Li, Joshua; Wong, Stanley Sau Ching; Tsang, Julia Y. S.; Ni, Yun‐Bi; Chen, Jie; Tse, Gary M.

doi:10.1136/jclinpath-2016-204138

Cited by 20 publications

(12 citation statements)

References 25 publications

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“…The ROM of an atypical diagnosis varies in the literature from 22 to 39% [10, 14, 52-57], reflecting the variability of the definition and usage of the term “atypical” in the literature. Two more recent studies that looked at applying the IAC Yokohama System had ROM of 13 and 15.7% [16, 17].…”

Section: Category: Atypicalmentioning

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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Section: Category: Atypicalmentioning

confidence: 99%

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

et al. 2019

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“…Rapid on‐site evaluation of cytology specimen adequacy by a pathologist at the time of acquisition has been shown to improve FNAC diagnostic yield, resulting in performances comparable to CNB . Benefits of FNAC over CNB include low procedural cost, quick turn‐around time, minimal complications, essentially no contraindications and reduced patient anxiety with near‐immediate patient follow‐up . Of additional importance are advancements in molecular and prognostic marker testing that allow necessary hormone receptor (i.e.…”

Section: Introductionmentioning

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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“…Overall, high specificity and low sensitivity data is echoed across individual studies and also in those presenting with symptomatic nipple discharge, 60,61 with a diagnostic accuracy for malignancy of only 31%. 60 The reason for such low sensitivity of nipple aspirate fluid is that discharge is often ''physiological'' in nature, has a generally high acellular or paucicellular composition, 58,62,63 and therefore is thought to consist almost exclusively of background debris and/or proteinaceous material. 58,64 Methods for NAF evaluation, whether they be cytological assessment or otherwise, suffer as a result of the relatively high proportion of ''non-yielders'': women in whom techniques to obtain NAF fail.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of Nipple Aspirate Fluid Cytology in Asymptomatic Patients: A Meta-analysis and Systematic Review of the Literature

et al. 2020

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Purpose To calculate the diagnostic accuracy of nipple aspirate fluid (NAF) cytology. Background Evaluation of NAF cytology in asymptomatic patients conceptually offers a non-invasive method for either screening for breast cancer or else predicting or stratifying future cancer risk. Methods Studies were identified by performing electronic searches up to August 2019. A meta-analysis was conducted to attain an overall pooled sensitivity and specificity of NAF for breast cancer detection. Results A search through 938 studies yielded a total of 19 studies. Overall, 9308 patients were examined, with cytology results from 10,147 breasts [age (years), mean ± SD = 49.73 ± 4.09 years]. Diagnostic accuracy meta-analysis of NAF revealed a pooled specificity of 0.97 (95% CI 0.97–0.98), and sensitivity of 0.64 (95% CI 0.62–0.66). Conclusions The diagnostic accuracy of nipple smear cytology is limited by poor sensitivity. If nipple fluid assessment is to be used for diagnosis, then emerging technologies for fluid biomarker analysis must supersede the current diagnostic accuracy of NAF cytology.

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Atypical aspirates of the breast: a dilemma in current cytology practice

Cited by 20 publications

References 25 publications

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

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

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

Diagnostic Accuracy of Nipple Aspirate Fluid Cytology in Asymptomatic Patients: A Meta-analysis and Systematic Review of the Literature

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