Department of Pathology and Laboratory medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, India.
Department of Surgical Oncology, All India Institute of Medical Sciences (AIIMS), Jodhpur, India.
Acta Cytol. 2021;65(6):483-493. doi: 10.1159/000518790. Epub 2021 Sep 14.
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.
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).
Out of 1,089 cases, 4.3% (n = 47) cases were categorized as insufficient, 82% (n = 893) as benign, 2.8% (n = 31) as atypical, 2.7% (n = 29) as suspicious of malignancy, and 8.2% (n = 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%.
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.
国际细胞学学会（IAC）横滨系统用于报告乳腺细针抽吸活检（FNAB）细胞学，旨在规范乳腺 FNAB 报告。本研究旨在根据 IAC 系统对触诊引导的无影像学指导的乳腺 FNAB 病例进行分类，确定各分类的恶性肿瘤风险（ROM），并评估该系统在资源匮乏/经济受限环境下的实用性、局限性和影响。
回顾性分析 2016 年 1 月至 2019 年 12 月期间触诊引导的无影像学指导的乳腺病变 FNAB，有随访活检的病例进行相关性分析。共对 1089 例病例采用 IAC 横滨系统重新分类，400 例有组织病理学随访。分析 ROM、阳性预测值（PPV）和阴性预测值（NPV）。
1089 例病例中，4.3%（n=47）为不充分，82%（n=893）为良性，2.8%（n=31）为非典型，2.7%（n=29）为疑似恶性，8.2%（n=89）为恶性。其中 400 例有随访活检，根据随访结果，各分类的 ROM 分别为 33.3%、0.4%、37.5%、96%和 100%。良性分类的 NPV 为 99.6%。恶性分类的 PPV 为 100%，可疑恶性和恶性分类的 PPV 为 99%，非典型、可疑恶性和恶性分类的 PPV 为 90.6%。
IAC 横滨系统有助于规范乳腺病变细胞学报告。有影像学引导的 FNAB 是理想的，但在资源/财力受限的情况下，如果测试结果为良性、可疑恶性或恶性，触诊引导的 FNAB 是可行的，本研究中这三种情况占 91.5%。对于不充分/不充足或非典型分类的病例，应建议重复超声引导的 FNAB 和/或核心针活检。
