McHugh Kelsey E, Bird Peter, Sturgis Charles D
Department of Laboratory Medicine, Cleveland Clinic, Cleveland, OH, USA.
Department of Surgery, AIC Kijabe Hospital, Kijabe, Kenya.
Cytopathology. 2019 Sep;30(5):519-525. doi: 10.1111/cyt.12696. Epub 2019 Apr 22.
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.
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.
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.
FNAC remains a valuable tool in evaluation of palpable breast lesions in resource-limited healthcare settings.
在评估可触及乳腺病变方面，细针穿刺抽吸细胞学检查（FNAC）有诸多优点。我们着手确定在肯尼亚农村资源有限的医疗环境中，乳腺FNAC检查结果与后续手术病理结果的一致性。
回顾性分析了非洲内陆教会基贾贝医院1999年1月至2017年9月的电子病理档案。确定了所有乳腺FNAC病例及后续手术病理标本。FNAC检查结果根据国际细胞学会横滨编码进行分类：标本不足；良性；非典型倾向良性；可疑倾向恶性；恶性。手术病理结果分为良性或恶性。
共识别出695例乳腺FNAC检查病例。其中219例（31.5%）随后进行了手术病理检查。患者平均年龄为39岁（范围13 - 88岁）；95%为女性。几乎所有（98%）病变均可触及。FNAC检查结果分类如下：标本不足20例（9%），良性103例（47%），非典型16例（7%），可疑24例（11%），恶性56例（26%）。组织病理学检查显示，良性病例141例（64%），恶性病例78例（36%）（表1）。FNAC检查诊断恶性病变的敏感性为85%；特异性为75%。阳性和阴性预测值分别为69%和88%。FNAC检查与组织病理学检查的诊断一致性为79%。对于明确诊断的FNAC分类，诊断一致性为89%。组织病理学检查中，标本不足的病例无恶性诊断，良性病例中有12例（12%）、非典型病例中有4例（25%）、可疑病例中有11例（46%）、恶性病例中有51例（91%）被诊断为恶性。有5例假阳性细胞病理学检查结果和12例假阴性结果。
在资源有限医疗环境中，FNAC检查仍是评估可触及乳腺病变的一项重要工具。
