The International Academy of Cytology Yokohama System for Reporting Breast Fine Needle Aspiration Biopsy Cytopathology: A Single Institutional Retrospective Study of the Application of the System Categories and the Impact of Rapid Onsite Evaluation

2019 ◽  
Vol 63 (4) ◽  
pp. 280-291 ◽  
Author(s):  
Stephen Wong ◽  
Mary Rickard ◽  
Peter Earls ◽  
Lauren Arnold ◽  
Barnabas Bako ◽  
...  
Keyword(s):  
Fine Needle Aspiration ◽  
Predictive Value ◽  
Fine Needle Aspiration Biopsy ◽  
Needle Aspiration ◽  
Aspiration Biopsy ◽  
Fine Needle ◽  
Needle Aspiration Biopsy ◽  
Effective Diagnosis ◽  
The Impact ◽  
International Academy

Objectives: To review the performance and utility of the International Academy of Cytology (IAC) Yokohama System for Reporting Breast Fine Needle Aspiration Biopsy (FNAB) Cytology five category stratification and evaluate the impact of rapid onsite evaluation (ROSE). Method: A retrospective analysis of breast FNAB cytology cases with matched histopathological results at a single institution over a 32 months period using a structured reporting system with 5 diagnostic categories (“inadequate/insufficient,” “benign,” “atypical,” “suspicious of malignancy” and “malignant”) closely paralleling the proposed IAC System. Results: Of 2,696 breast FNAB cases, there were 579 with matched histopathology and 456 of these had ROSE. ROSE decreased the number in the “insufficient” category (17.1% without ROSE to 4.0% with ROSE) and increased the number in the “malignant” (17.9 to 39.0%) with a lesser impact on the “atypical,” “benign” and “suspicious of malignancy” categories. The performance data showed a positive predictive value of 96.4%, negative predictive value of 97.6%, and a risk of malignancy of a FNAB categorized as “insufficient” to be 2.6%, “benign” 1.7%, “atypical” 15.7%, “suspicious of malignancy” 84.6%, and “malignant” 99.5%. Conclusion: Breast FNAB is an accurate test enabling effective diagnosis of breast lesions. ROSE improved the performance by decreasing the proportion of “insufficient” and “atypical” and increasing the “suspicious of malignancy” and “malignant” diagnoses and enabling immediate triage for further biopsy where necessary.

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

2019 ◽  
Vol 63 (4) ◽  
pp. 257-273 ◽  
Author(s):  
Andrew S. Field ◽  
Wendy A. Raymond ◽  
Mary Rickard ◽  
Lauren Arnold ◽  
Elena F. Brachtel ◽  
...  
Keyword(s):  
Fine Needle Aspiration ◽  
Predictive Value ◽  
Fine Needle Aspiration Biopsy ◽  
Needle Aspiration ◽  
Aspiration Biopsy ◽  
Breast Lesions ◽  
Fine Needle ◽  
Management Algorithm ◽  
Needle Aspiration Biopsy ◽  
International Academy

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.

Risk Stratification of Breast Fine-Needle Aspiration Biopsy Specimens Performed without Radiologic Guidance by Application of the International Academy of Cytology Yokohama System for Reporting Breast Fine-Needle Aspiration Cytopathology

2021 ◽  
pp. 1-11
Author(s):  
Sujata Sarangi ◽  
Meenakshi Rao ◽  
Poonam Abhay Elhence ◽  
Aasma Nalwa ◽  
Jyotsna N. Bharti ◽  
...  
Keyword(s):  
Fine Needle Aspiration ◽  
Predictive Value ◽  
Fine Needle Aspiration Biopsy ◽  
Needle Aspiration ◽  
Aspiration Biopsy ◽  
Breast Lesions ◽  
Fine Needle ◽  
Needle Aspiration Biopsy ◽  
International Academy

<b><i>Background and Objective:</i></b> The International Academy of Cytology (IAC) Yokohama system for reporting breast fine-needle aspiration biopsy (FNAB) cytopathology has been proposed to standardize breast FNAB reporting. The aim of this study was to categorize breast FNAB cases performed by palpation without radiological guidance according to the IAC system, establish the risk of malignancy (ROM) for the categories and assess the system’s utility, pitfalls, and implications in low-resource/financial constraint settings. <b><i>Methods:</i></b> A retrospective analysis of palpation-guided FNAB of breast lesions performed without radiological guidance between January 2016 and December 2019 was carried out and was correlated with follow-up biopsies wherever available. A total of 1,089 cases were recategorized using the IAC Yokohama system. Histopathology follow-up was available for 400 cases. The data were analysed for ROM, positive predictive value (PPV), and negative predictive value (NPV). <b><i>Results and Discussion:</i></b> Out of 1,089 cases, 4.3% (<i>n</i> = 47) cases were categorized as insufficient, 82% (<i>n</i> = 893) as benign, 2.8% (<i>n</i> = 31) as atypical, 2.7% (<i>n</i> = 29) as suspicious of malignancy, and 8.2% (<i>n</i> = 89) as malignant. Some 400 cases had a follow-up biopsy, based on which, the ROM for the categories were 33.3%, 0.4%, 37.5%, 96%, and 100%. The NPV for the benign category was 99.6%. The PPV of the malignant category was 100%, that of combined suspicious of malignancy and malignant categories was 99%, and of combined atypical, suspicious of malignancy, and malignant was 90.6%. <b><i>Conclusion:</i></b> The IAC Yokohama system is useful in standardizing the reporting of cytopathology of breast lesions. FNAB with radiological guidance is ideal but in cases of finance/resource constraints, FNAB by palpation alone is satisfactory if the test result is in the benign, suspicious of malignancy, or malignant categories, which constitute 91.5% of the cases in this study. A repeat ultrasound-guided FNAB and/or core needle biopsy should be recommended for cases in the insufficient/inadequate or atypical categories.

Accuracy of Breast Fine-Needle Aspiration Biopsy Using the International Academy of Cytology Yokohama System in Clinico-Radiologically Indeterminate Lesions: Initial Findings Demonstrating Value in Lesions of Low Suspicion of Malignancy

2021 ◽  
pp. 1-7
Author(s):  
Shruti Agrawal ◽  
Michael Leonard Anthony ◽  
Pranoy Paul ◽  
Divya Singh ◽  
Akansha Agarwal ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Fine Needle Aspiration ◽  
Fine Needle Aspiration Biopsy ◽  
Needle Aspiration ◽  
Aspiration Biopsy ◽  
Breast Lesions ◽  
Fine Needle ◽  
Malignant Lesions ◽  
Needle Aspiration Biopsy ◽  
International Academy

<b><i>Background:</i></b> Fine-needle aspiration biopsy (FNAB) in breast lesions offers accurate results in differentiating benign and malignant lesions. However, its role is unclear when core-needle biopsy (CNB) is available, the latter providing additional information regarding tumor grade, invasion, and hormone receptor status in malignant lesions. In benign breast lesions, especially in BIRADS category 4a and 4b, FNAB, and CNB provide similar pathological information, whereby FNAB may serve as a more rapid and cost-effective investigation. The study was planned to reevaluate the diagnostic accuracy of FNAB in BIRADS category 4a, 4b, and 4c lesions. <b><i>Materials and Methods:</i></b> FNAB and biopsy reports of all patients with breast lesions sent between September 1, 2018, and November 30, 2020, were collected and the International Academy of Cytology (IAC) Yokohama category and BIRADS score were recorded for each case. The rate of malignancy and the accuracy of FNAB in diagnosing malignancy were calculated for each BIRADS 4a, 4b, and 4c subgroup. <b><i>Results:</i></b> A total of 249 cases of BIRADS 4 lesions had corresponding cytology and histopathology diagnoses. FNAB showed high diagnostic accuracy in all BIRADS groups. A benign categorization was associated with a very low number of false-negative diagnoses, especially in BIRADS 4a lesions. <b><i>Conclusion:</i></b> The study reconfirms the excellent accuracy of breast FNAB using the IAC Yokohama system in diagnosing breast malignancies. Furthermore, BIRADS 4a lesions found to be belonging to the cytological benign category may be excluded from CRB and kept on clinical follow-up.

scholarly journals Fine-needle aspiration biopsy for breast lesions: a comparison between two devices for obtaining cytological samples

2005 ◽  
Vol 123 (6) ◽  
pp. 271-276 ◽  
Author(s):  
Ruffo Freitas Júnior ◽  
Marise Amaral Rebouças Moreira ◽  
Gustavo Antônio de Souza ◽  
Ellen Hardy ◽  
Regis Resende Paulinelli
Keyword(s):  
Fine Needle Aspiration ◽  
Predictive Value ◽  
Fine Needle Aspiration Biopsy ◽  
Needle Aspiration ◽  
Aspiration Biopsy ◽  
Breast Lesions ◽  
Fine Needle ◽  
Vacuum Device ◽  
Needle Aspiration Biopsy ◽  
Breast Lumps

CONTEXT AND OBJECTIVE: Fine-needle aspiration biopsy has been accepted worldwide for breast lesions. However, some questions remain, including the appropriateness of the puncture method. The objective of this work was to compare aspirates obtained by the auto-vacuum device and by the syringe pistol holder. DESIGN AND SETTING: Randomized trial for validation of diagnostic method, at Hospital das Clínicas da Universidade Federal de Goiás and Hospital Araújo Jorge, Goiânia. METHODS: 351 patients presenting breast lumps underwent fine-needle aspiration biopsy, either with the auto-vacuum device or the syringe pistol holder. A single cytopathologist analyzed all of the cytology slides. The rates of insufficient material, cellularity, cell distortion and background hemorrhage were evaluated. RESULTS: The percentages of insufficient material were 16% and 22% (p = 0.18), for the auto-vacuum and pistol aspirates, respectively. Good cellularity was seen in 34% of auto-vacuum and 29% of pistol samples (p = 0.4). Cell distortion was seen in 31 and 26 cases, respectively (p = 0.7). Background hemorrhage occurred in 63 (35%) and 54 cases (31%) (p = 0.2), for auto-vacuum and pistol. The sensitivity was 88% and 86%; specificity 99% and 100%, positive predictive value 96% and 100%, negative predictive value 96% and 95% and total accuracy 76% and 75% for the auto-vacuum and pistol, respectively. CONCLUSION: The results obtained from the two fine-needle aspiration biopsy methods were equivalent. Therefore, the auto-vacuum device is a good option for obtaining aspirates for cytology.

scholarly journals The predictive value of elastography in thyroid nodules and its comparison with fine-needle aspiration biopsy results

2014 ◽  
Vol 30 (3) ◽  
pp. 147-152
Author(s):  
Mehmet Celal Kizilkaya ◽  
Fazilet Erozgen ◽  
Muzaffer Akinci ◽  
Rafet Kaplan ◽  
Sefa Tuzun ◽  
...  
Keyword(s):  
Fine Needle Aspiration ◽  
Predictive Value ◽  
Thyroid Nodules ◽  
Fine Needle Aspiration Biopsy ◽  
Needle Aspiration ◽  
Aspiration Biopsy ◽  
Fine Needle ◽  
Needle Aspiration Biopsy

scholarly journals Comparison of power Doppler and thermography for the selection of thyroid nodules in which fine-needle aspiration biopsy is indicated

2016 ◽  
Vol 49 (5) ◽  
pp. 311-315 ◽  
Author(s):  
Maria Lucia D'Arbo Alves ◽  
Manoel Henrique Cintra Gabarra
Keyword(s):  
Fine Needle Aspiration ◽  
Predictive Value ◽  
Thyroid Nodules ◽  
Fine Needle Aspiration Biopsy ◽  
Power Doppler ◽  
Needle Aspiration ◽  
Aspiration Biopsy ◽  
Fine Needle ◽  
Needle Aspiration Biopsy ◽  
Selection Of

Abstract Objective: To compare two methods-power Doppler and thermography-for the analysis of nodule vascularization and subsequent selection of nodules to be biopsied. Materials and Methods: A total of 510 subjects with thyroid nodules were analyzed by power Doppler and submitted to fine-needle aspiration biopsy (FNAB). Thirty-seven patients were submitted to nodule excision (29 due to carcinoma or suspected carcinoma and 8 by patient choice). Among those patients, power Doppler had raised the suspicion of malignancy in 39 lesions, compared with 48 for FNAB. Another group, comprising 110 patients, underwent thermography, which raised the suspicion of malignancy in 124 thyroid nodules, as did FNAB. Malignant nodules were excised in all 110 of those patients (95 underwent nodulectomy and 15 underwent thyroidectomy), malignancy being confirmed by intraoperative examination of frozen biopsy samples. Results: In relation to the FNAB findings, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of power Doppler were 95.16%, 23.52%, 96.22%, 16.70%, and 89.51%, respectively, compared with 100%, 58.06%, 87.73%, 100%, and 89.51%, respectively, for thermography. Conclusion: Thermography was more precise than was power Doppler for the selection of thyroid nodules to be biopsied.

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