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

Abstract

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

Accuracy of the International Academy of Cytology Yokohama system of breast cytology reporting for fine needle aspiration biopsy of the breast in a dedicated breast care setting

“…Even then, the ROM of the atypical, suspicious of malignancy and malignant cytological categories in our study is compatible with the expected ROM of the IAC Yokohama system 14,15 . The diagnostic accuracy of breast FNAB by the IAC Yokohama system in the present study is similar to previous reported studies when the latter are re‐analyzed 15‐18 (Table 5), with the high AUC reported in the studies confirming the high diagnostic accuracy of breast FNAB.…”

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

“…The IAC Yokohama System has defined minimum criteria for adequacy and recommends the inadequate rates (category I) be less than 5%. Category I in published studies ranges from 5.7% to 40% 9‐14 . Our study reports a higher percentage of inadequate aspirates (9%) than that recommended by IAC, despite being comparable to other recently published Indian and Western studies 9‐14 …”

“…Category I in published studies ranges from 5.7% to 40% 9‐14 . Our study reports a higher percentage of inadequate aspirates (9%) than that recommended by IAC, despite being comparable to other recently published Indian and Western studies 9‐14 …”

Categorization of Breast Fine Needle Aspirates Using the International Academy of Cytology Yokohama System Along with Assessment of Risk of Malignancy and Diagnostic Accuracy in a Tertiary Care Centre

“…McHugh et al . [ 12 ] observed highest sensitivity and specificity in similar scenarios, but they observed maximum accuracy when only malignant cases were considered as positive test results [ Table 5 ].…”