The continuing role of breast fine‐needle aspiration biopsy after the introduction of the IAC Yokohama System For Reporting Breast Fine Needle Aspiration Biopsy Cytopathology

Abstract

Background: Ultrasound-guided fine-needle aspiration biopsy (FNAB) (US-guided FNAB) is a rapid and cost-effective procedure for the diagnosis of breast lesions. Our Institution has a long tradition in breast FNAB performed by cytopathologists; recently we adopted both US guidance and a five-tiered classification system similar to that proposed by the International Academy of Cytology (IAC). The aim of this study was to demonstrate the continuing role of US-guided FNAB in the diagnosis of breast lesions, despite the growing adoption of core-needle biopsy (CNB). Methods: The laboratory information database system was searched to obtain the breast FNAB diagnostic reports recorded from 2010 to 2017 and classified using a five-tiered Classification System; each entry was matched with the available histology. Results: A total of 4624 breast FNAB samples were retrieved. Of these, 1745/4624 cases (37.7%) had histological follow-ups. The risk of malignancy (ROM) was 4.9% for benign, 20.7% for atypical, 78.7% for suspicious of malignancy, and 98.8% for malignant. When the atypical category was evaluated as a negative index, the positive predictive value was 93.73%, and the negative predictive value was 90.78%, reaching an overall diagnostic accuracy of 92.82%. Conclusions: The IAC Yokohama System for Reporting Breast FNAB Cytopathology clearly identifies different diagnostic categories with increasing ROM. Most of the FNAB samples were classified as benign or malignant (65.3%), warranting prompt management for these patients. Moreover, the inclusion of the atypical category as a low-risk indeterminate category avoided overtreatment of benign lesions. Thus, despite the well-established merits of CNB, US-guided FNAB still represents a costeffective and rapid nonoperative diagnostic approach.

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.…”

Implementation of the International Academy of Cytology Yokohama standardized reporting for breast cytopathology: An 8‐year retrospective study

“…A comprehensive literature search through PubMed database identified a total of seven studies implementing IAC Yokohama reporting system for breast FNAB. [6][7][8][9][10][11][12] A comparison of the test performance across these studies was highlighted in Table 5.…”

The role of breast fine needle aspiration during and post‐COVID‐19 pandemic: A fast and safe alternative to needle core biopsy

“…When a diagnosis of low‐grade ductal in situ carcinoma is made (in the atypical or suspicious categories), a biopsy may be necessary. However, a recent series from an Italian reference centre has shown that, when performed by experienced cytopathologists following the Yokohama system, the majority of diagnoses are either benign or malignant 31 …”