Department of Pathology, ESI Medical College and Post Graduate Institute of Medical Sciences and Research, Bangalore, India.
Acta Cytol. 2023;67(5):482-492. doi: 10.1159/000531463. Epub 2023 Jun 16.
The early diagnosis of breast carcinoma is of paramount importance in its management. Fine-needle aspiration cytology (FNAC) has the potential to play a pivotal role in providing the relevant information on the aggressiveness of this tumor. But there is no gold standard when it comes to cytological grading of breast carcinoma as there is no consensus between the pathologists and also the clinicians as to which grading is as par with the gold standard Elston-Ellis modification of Scarff-Bloom-Richardson (SBR) histological grading. This study was undertaken to study seven cytological 3-tier grading systems, namely, Robinson's, Fisher's, Mouriquand's, Dabbs', Khan's, Taniguchi's, and Howells's and to correlate them with the Elston-Ellis modification of SBR histological grading system so as to determine the finest cytological grading system which could be reliably used in our routine practice.
A total of 117 breast carcinoma cases diagnosed on FNAC were graded using seven 3-tier cytological grading systems and were correlated with Elston-Ellis modification of SBR histological grading system. Concordance, kappa measurement, and various correlation studies were done using SPSS software version 2021.
Robinson's method showed a better concordance (84.61%), a better correlation (Spearman = 0.750, τ = 0.731, p < 0.001), and a substantial kappa value of agreement (κ = 0.701) with SBR grading system compared to other system closely followed by Fisher's system.
Even though all the seven 3-tier cytological grading systems positively correlated with the SBR histologic grading of breast carcinoma, Robinson's method showed better concordance and correlation with a substantial kappa value of agreement in comparison to other 3-tier cytology grading systems. Hence, Robinson's grading which is simpler and also feasible should be incorporated in the routine cytology reporting of breast carcinoma.
早期诊断乳腺癌在其治疗中至关重要。细针吸取细胞学（FNAC）有可能在提供有关肿瘤侵袭性的相关信息方面发挥关键作用。但是，由于病理学家和临床医生之间没有共识，也没有关于乳腺癌细胞学分级的金标准，因此哪种分级与 Scarff-Bloom-Richardson（SBR）组织学分级的 Elston-Ellis 改良版相当。本研究旨在研究七种细胞学 3 级分级系统，即 Robinson、Fisher、Mouriquand、Dabbs、Khan、Taniguchi 和 Howells，并将其与 SBR 组织学分级系统的 Elston-Ellis 改良版进行相关性分析，以确定最适合在我们的常规实践中使用的细胞学分级系统。
对 117 例经 FNAC 诊断为乳腺癌的病例进行了七种 3 级细胞学分级系统的分级，并与 SBR 组织学分级系统的 Elston-Ellis 改良版进行了相关性分析。使用 SPSS 软件版本 2021 进行一致性、kappa 测量和各种相关性研究。
与其他系统相比，Robinson 方法显示出更好的一致性（84.61%）、更好的相关性（Spearman = 0.750，τ=0.731，p < 0.001）和实质性的kappa 一致性值（κ=0.701）与 SBR 分级系统。其次是 Fisher 系统。
尽管所有七种 3 级细胞学分级系统与乳腺癌的 SBR 组织学分级均呈正相关，但与其他 3 级细胞学分级系统相比，Robinson 方法的一致性和相关性更好，kappa 值也更高。因此，Robinson 分级更简单且可行，应纳入乳腺癌常规细胞学报告中。
