Division of Anatomical Pathology, National Health Laboratory Service, Tygerberg Hospital, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa,
Division of Anatomical Pathology, National Health Laboratory Service, Tygerberg Hospital, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Acta Cytol. 2021;65(2):132-139. doi: 10.1159/000512041. Epub 2020 Dec 17.
This study aims to determine the diagnostic utility of the International Academy of Cytology (IAC) Yokohama System for reporting breast cytopathology in lesions of the male breast.
Fine-needle aspiration biopsy (FNAB) reports between 2015 and 2019 were retrospectively recategorized according to the 5-tiered IAC Yokohama Reporting System. Our database yielded a total of 1,532 FNAB reports from breast lesions, obtained from 1,350 male patients. The risk of malignancy (ROM) and diagnostic performance of FNAB were determined using follow-up histopathological diagnosis and/or clinical follow-up, where available, for each category.
The category distribution were as follows: inadequate, 40%; benign, 57%; atypical, 0.6%; suspicious for malignancy, 0.7%; and malignant, 1.6%. The ROM in each category was nondiagnostic, 11%; benign, 3%; atypical, 28%; suspicious for malignancy, 56%; and malignant, 100%. The sensitivity, specificity, positive predictive value, and negative predictive value were recorded as 63, 100, 100, and 84.6% respectively, when only malignant cases were considered as positive tests.
This study validates the IAC Yokohama System for reporting male breast cytopathology. In accordance with the aim of the Yokohama System to establish best practice guidelines for reporting breast cytopathology, this comprehensive scheme facilitates comparisons between local and international institutions. The ROM acts as an internal audit for quality assurance within one's own laboratory and provides guidance for clinical management. It highlights inefficiencies such as high inadequacy rates for category 1 and also features strengths with impressive specificity for categories 4 and 5.
本研究旨在确定国际细胞学学会（IAC）横滨系统在报告男性乳腺病变的乳腺细胞学中的诊断效用。
根据 5 级 IAC 横滨报告系统，对 2015 年至 2019 年的细针穿刺活检（FNAB）报告进行回顾性重新分类。我们的数据库共包含 1350 名男性患者的 1532 份乳腺病变 FNAB 报告。使用每种分类的随访组织病理学诊断和/或临床随访来确定恶性风险（ROM）和 FNAB 的诊断性能。
分类分布如下：不充分，40%；良性，57%；非典型，0.6%；可疑恶性，0.7%；恶性，1.6%。每个类别中的 ROM 分别为：无诊断价值，11%；良性，3%；非典型，28%；可疑恶性，56%；恶性，100%。当仅考虑恶性病例为阳性测试时，灵敏度、特异性、阳性预测值和阴性预测值分别记录为 63%、100%、100%和 84.6%。
本研究验证了 IAC 横滨系统在报告男性乳腺细胞学中的应用。根据横滨系统的目标，即建立报告乳腺细胞学的最佳实践指南，该综合方案有助于在本地和国际机构之间进行比较。ROM 作为内部质量保证审核，为临床管理提供指导。它突出了 1 类不充分率高的效率低下问题，同时还展示了 4 类和 5 类令人印象深刻的特异性优势。
