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The continuing role of breast fine‐needle aspiration biopsy after the introduction of the IAC Yokohama System For Reporting Breast Fine Needle Aspiration Biopsy Cytopathology
Author(s) -
De Rosa Filippo,
Migliatico Ilaria,
Vigliar Elena,
Salatiello Maria,
Pisapia Pasquale,
Iaccarino Antonino,
Russo Daniela,
Insabato Luigi,
Accurso Antonello,
Arpino Grazia,
Palombini Lucio,
Troncone Giancarlo,
Bellevicine Claudio
Publication year - 2020
Publication title -
diagnostic cytopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.417
H-Index - 65
eISSN - 1097-0339
pISSN - 8755-1039
DOI - 10.1002/dc.24559
Subject(s) - medicine , cytopathology , fine needle aspiration , biopsy , malignancy , radiology , cytology , pathology
Background Ultrasound‐guided fine‐needle aspiration biopsy (FNAB) (US‐guided FNAB) is a rapid and cost‐effective procedure for the diagnosis of breast lesions. Our Institution has a long tradition in breast FNAB performed by cytopathologists; recently we adopted both US guidance and a five‐tiered classification system similar to that proposed by the International Academy of Cytology (IAC). The aim of this study was to demonstrate the continuing role of US‐guided FNAB in the diagnosis of breast lesions, despite the growing adoption of core‐needle biopsy (CNB). Methods The laboratory information database system was searched to obtain the breast FNAB diagnostic reports recorded from 2010 to 2017 and classified using a five‐tiered Classification System; each entry was matched with the available histology. Results A total of 4624 breast FNAB samples were retrieved. Of these, 1745/4624 cases (37.7%) had histological follow‐ups. The risk of malignancy (ROM) was 4.9% for benign, 20.7% for atypical, 78.7% for suspicious of malignancy, and 98.8% for malignant. When the atypical category was evaluated as a negative index, the positive predictive value was 93.73%, and the negative predictive value was 90.78%, reaching an overall diagnostic accuracy of 92.82%. Conclusions The IAC Yokohama System for Reporting Breast FNAB Cytopathology clearly identifies different diagnostic categories with increasing ROM. Most of the FNAB samples were classified as benign or malignant (65.3%), warranting prompt management for these patients. Moreover, the inclusion of the atypical category as a low‐risk indeterminate category avoided overtreatment of benign lesions. Thus, despite the well‐established merits of CNB, US‐guided FNAB still represents a cost‐effective and rapid nonoperative diagnostic approach.