Diagnostic accuracy of fine-needle aspiration cytology of the breast in Japan: Report from the Working Group on the Accuracy of Breast Fine-Needle Aspiration Cytology of the Japanese Society of Clinical Cytology

Abstract

The Working Group of the Japanese Society of Clinical Cytology was assembled to assess the current status of breast cytology in Japan by conducting a large-scale survey regarding the accuracy of fine-needle aspiration biopsy (FNAB) in Japan. We collected data and investigated the status of breast cytological diagnosis at 12 different cooperating facilities in Japan, and re-evaluated their false-negative and false-positive cases. Among 30,535 individuals who underwent a breast cytological examination, analyses were conducted on 10,890 individuals (35.7%) in whom cytological diagnoses were confirmed by histology. Among these patients, the cytological diagnosis had an inadequate rate of 17.7%, an indeterminate rate of 7.8%, a positive predictive value of 'malignancy suspected' cells of 92.4%, an absolute sensitivity of 76.7%, a complete sensitivity of 96.7%, a specificity of 84.3%, a positive predictive value of 'malignant' cells of 99.5%, a false-negative value of 3.31%, a false-positive value of 0.25% and an accuracy rate of 88.0%. Subsequently, 297 false-negative and 23 false-positive cases were re-evaluated and several factors were characterized (i.e. histological type, tumor size and misread points). This survey collected data from a large number of cases for breast FNAB. Based on our survey, the accuracy of FNAB in Japan was relatively high compared with the goal of assessment of diagnostic accuracy. However, there were some false-negative and false-positive cases. Improvements in accuracy resulting from the learning points in the present study will lead to more useful and reliable diagnostic tools in clinical practice.

Usefulness of second-look ultrasonography using anatomical breast structures as indicators for magnetic resonance imaging-detected breast abnormalities

“…Moreover, we reviewed three false-positive cases. The histopathological results showed mastopathy-type fibroadenoma, mastopathy accompanied by apocrine metaplasia, and various findings of mastopathy, consistent with the WGJSCC report [21].…”

“…We performed FNAC diagnosis of all lesions identified as targets in this study. Thereafter, we compared our FNAC results with those generated by the analysis of 10,890 cases at 12 facilities compiled by the Japan Society of Clinical Cytology Working Group (WGJSCC) [21].…”

International Academy of Cytology Yokohama System for Reporting Breast Fine-Needle Aspiration Biopsy Cytopathology: A Review of Predictive Values and Risks of Malignancy

“…Breast cancer metastases to regional lymph nodes or distant sites are related topics and are not discussed here. Breast FNAB plays an increasing role for breast cancer diagnostics globally, and standardized reporting is of high importance to increase diagnostic confidence and compare of outcomes between diverse clinical settings [5, 10-12, 30-33]. …”

Fluorescence‐based discrimination of breast cancer cells by direct exposure to 5‐aminolevulinic acid

“…Regarding the pathological diagnosis of breast cancer, fine needle aspiration (FNA) cytology (FNAC) has been widely used for primary screening; however, despite its well accepted and classical means, its diagnostic validity has been limited due to the absence of objective or definitive evidence for cells being cancer or noncancer. The interpretation of FNAC samples depends entirely upon the cytopathologists’ subjective judgments based on certain empirical diagnostic criteria, where sensitivity and specificity of breast cancer diagnosis are variables ranging from 35% to 95% and from 48% to 100%, respectively .…”