IP Archives of Cytology and Histopathology Research

Print ISSN: 2581-5725

Online ISSN: 2456-9267

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Sunitha, Chandra, Rambabu, and Krishna Kanth: Application of IAC Yokohama system for breast cytology – The experience at a tertiary care hospital


Introduction

Breast malignancies are one of the commonest malignancies in Indian women. Increasing urbanization is attributed to raise of breast cancers and have surpassed cervix cancer in recent times and are now ranked top in some metros. 1 FNA is used as an important diagnostic tool as a part of triple assessment. The international academy of cytology system for reporting breast fine needle aspiration cytology was formed in the year 2016 by a set of cytopathologists, radiologists, surgeons, and oncologists. 2 According to IAC Yokohama system of reporting breast cytology, 5 different categories have been classified as follows:

  1. Insufficient / Inadequate

  2. Benign

  3. Atypical, probably benign

  4. Suspicious of malignancy

  5. Malignant

This type of reporting is helpful in organizing the way of reporting breast FNA samples. It provides more appropriate information to the clinician in decision making for patient care management and improves mutual communication.3 Also the FNA procedure has the advantage of being easier, quicker to perform and less cumbersome. By using the IAC Yokohama system the samples received in our pathology department were classified into different categories and ROM was also calculated for the same.

Materials and Methods

The present study was carried out in the department of pathology, ESIC medical college and hospital, Sanathnagar, Hyderabad, India. The study was carried out over a period of 2 years, retrospectively from June 2019 to May 2021. 305 breast FNA samples were collected and categorized according to the IAC Yokohama system for reporting breast cytopathology. All were female patients. 95 cases of these had histopathological correlation and statistical parameters, ROM were calculated on the obtained data.

P-value was also calculated by using the chi-square test.

Results

A total of 305 FNA samples were obtained and all these are categorized according to the IAC Yokohama system after thorough review by an experienced pathologist. The age group for all the cases was 11 – 80 yrs (Table 1) and those cases with palpable breast lump were taken. The most common age group with lump in the breast observed in our study was 31 – 40 yrs. The earliest age presented with breast malignancy was 33 and we have observed 10 malignancies in the age group of 31 – 40 yrs.

All the FNA samples obtained are put in one of the 5 categories according to the IAC Yokohama system of reporting. The percentage distribution of cases according to IAC Yokohama are shown in (Table 2).

For 305 FNA samples received, 95 cases were obtained for HPE correlation (Table 3). The ROM is calculated for each category. Sensitivity, Specificity, PPV, NPV, Diagnostic accuracy are calculated for the present study using MS EXCEL sheet.

Chi-square test for categorical data was used for calculation of p-value to assess statistical significance (Table 4). p-value < 0.05 is considered as significant. In the present study p- value obtained was 0.0001 which is very significant.

Table 1

Age distribution of FNA samples

Age range

No. of cases

11 – 20

24

21 – 30

72

31 – 40

96

41 – 50

81

51 – 60

27

61 – 70

4

71 – 80

1

Table 2

Distribution of cases according to IAC Yokohama system

IAC yokohama category

Total no. of cases

% of distribution

Insufficient

21

6.89%

Benign

221

72.46%

Atypical

10

3.28%

Suspicious of malignancy

10

3.28%

Malignant

43

14.09%

Total

305

100%

Table 3

Cyto – histopathology correlation

IAC yokohama category

Cytology

Histopathology

Insufficient

21

4

Benign

221

50

Atypical

10

5

Suspicious of malignancy

10

7

Malignant

43

29

Total

305

95

Table 4

Distribution of histopathological cases according to IAC Yokohama and chi-square and p-value calculation

IAC yokohama categories

Benign

Malignant

Total

Chi- square value

P-value

Insufficient

4

0

4

83. 115

<0.0001

Benign

49

1

50

Atypical

5

0

5

Suspicious of malignancy

2

5

7

Malignant

0

29

29

Total

58

35

95

Table 5

Risk of malignancy for each category

IAC yokohama categories

ROM

Insufficient

0%

Benign

2%

Atypical probably benign

0%

Suspicious of malignancy

71.43%

Malignant

100%

Table 6

Statistical analysis

Statistical parameters

Percentage

Sensitivity

100%

Specificity

96.66%

Positive predictive value

94.59%

Negative predictive value

100%

Diagnostic accuracy

97.89%

Figure 1

H&E-Showing ductal epithelial cell cluster under 100x

https://s3-us-west-2.amazonaws.com/typeset-prod-media-server/a3ffa3f9-93f0-4cae-a445-688035b10933image1.png
Figure 2

H&E-Showing benign ductal epithelial cell cluster under 40x

https://s3-us-west-2.amazonaws.com/typeset-prod-media-server/a3ffa3f9-93f0-4cae-a445-688035b10933image2.png
Figure 3

H&E- cluster of ductal epithelial cell lacking myoepithelial layer under 100X

https://s3-us-west-2.amazonaws.com/typeset-prod-media-server/a3ffa3f9-93f0-4cae-a445-688035b10933image3.png
Figure 4

H&E- Loose cohesive cells with anisonucleosis under 100x

https://s3-us-west-2.amazonaws.com/typeset-prod-media-server/a3ffa3f9-93f0-4cae-a445-688035b10933image4.png
Figure 5

H&E-Cluster of highly pleomorphic cells with increased N:C ratio

https://s3-us-west-2.amazonaws.com/typeset-prod-media-server/a3ffa3f9-93f0-4cae-a445-688035b10933image5.png
Figure 6

H&E- Dispersed arrangement of pleomorphic cells under 40x

https://s3-us-west-2.amazonaws.com/typeset-prod-media-server/a3ffa3f9-93f0-4cae-a445-688035b10933image6.png

Discussion

Breast FNA is a quick, precise and highly convenient diagnostic procedure which can be done in OPD. It has less complications and can diagnose a wide spectrum of diseases with high accuracy and has less turnaround time than HPE. So in this era of core biopsies, FNA is still continuing as an important diagnostic tool along with clinical imaging and self assessment as a part of triple assessment. It has high sensitivity, specificity and high reproducibility.4, 5, 6, 7, 8, 9, 10, 11   

In our study, we observed the most common age group affected with breast malignancies are between 31 – 40 yrs and the earliest age group presenting with breast lump was 13 years. The present study is comparable to Badge SA et al 12 and Sreedevi CH et al13 where there are no malignant cases in the age group of 11-20yrs. In our study we have observed 1 malignant case in the age group 21-30 and no malignant cases between 71-80. This could be because of increased incidence of breast cancers in younger age group when compared to elderly probably because of urbanization. The % of benign and malignant cases obtained in the present study is comparable to the studies of Sreedevi CH et al13 and Badge SA et al. 12(Table 7)

Table 7

Comparison of age wise distribution of FNA cases

Age

Sreedevi CH et al 13

Badge SA et al 14

Present study

Benign

Malignant

Benign

Malignant

Benign

Malignant

11-20

22

0

10

0

24

0

21-30

36

0

36

0

71

1

31-40

17

4

82

17

84

12

41-50

8

4

27

29

61

20

51-60

2

5

7

4

11

16

61-70

0

1

0

6

2

2

71-80

1

0

0

2

1

0

Total

86(86%)

14(14%)

162(73.63%)

58(26.37%)

254(83.27%)

51(16.73%)

In the present study we obtained 305 breast FNA samples of female patients and these were categorized into one of the 5 given categories according to the IAC Yokohama system and the number of cases obtained in each category was subsequently compared with other studies done in India and

elsewhere showing that the relative proportion of malignant cases are growing in the Indian context.(Table 8)

Table 8

Comparison of IAC Yokohama distribution of cases with other studies

IAC Yokohama Category

Montezuma D et al., 14

Wong S et al., 15

Poornima V Kamatar et al., 16

Apuroopa M et al., 17

Present study

Insufficient

209 (5.77%)

301 (11%)

22 (5%)

39 (4.3%)

21 (6.89%)

Benign

2660 (73.38%)

1937 (72%)

332 (71%)

522(58%)

221 (72.46%)

Atypical probably benign

498 (13.74%)

117 (4.3%)

7 (1%)

160 (17.7)

10 (3.28%)

Suspicious

57 (1.57%)

59 (2.2%)

8 (2%)

63 (7.2%)

10 (3.28%)

Malignant

201 (5.54%)

278 (10%)

101 (21%)

116 (12.8%)

43 (14.09%)

Total

3625

2696

470

900

305

ROM calculated for each category was comparable to the study of Poornima V Kamatar et al., 16 In the present study we observed 0% ROM in insufficient and atypical categories. Atypia associated with malignant lesions has been appropriately recognized and was put up in higher categories which is responsible for low ROM with atypical category. The ROM is comparatively less in the present study when compared to other studies. So, more diligence has to be paid in categorizing suspicious lesions.(Table 9)

Table 9

Comparison of ROM with other studies

IAC Yokohama Category

Montezuma D et al, 14

Poornima V Kamatar et al., 16

Apuroopa M et al., 17

Present study

Insufficient

4.8%

0%

5.0%

0%

Benign

1.4%

4%

1.2%

2%

Atypical probably benign

13%

66%

12.5%

0%

Suspicious

97.1%

83%

93.65%

74.43

Malignant

100%

99%

100%

100%

The sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy are calculated and these statistical parameters are comparable to studies of Moschetta M et al 18 We observed 100% sensitivity and negative predictive value in our studies.

p-value is also calculated for present study and it is <0.0001 which is very significant and it implies that the recognition of various Yokohama categories in ESIC setup has largely been successful and is comparable to the established standards of IAC Yokohama and this has helped the department in giving appropriate guidance to the surgeons in dealing with breast lesions.(table 10)

Table 10

Comparison of statistical parameters with other studies`

Statistical parameters

Montezuma D et al., 14

Moschetta M et al., 18

Poornima V Kamatar et al., 16

Apuroopa M et al.,17

Present study

Sensitivity

97.56%

97%

94.59%

95.9%,

100%

Specificity

100%

94%

98.9%

97.89%,

96.66%

Positive predictive value

100%

91%

98.59%

96.79%,

94.59%

Negative predictive value

98.62%

98%

95.74%

97.64%

100%

Diagnostic accuracy

99.11%

95%

96.97%

91.5 %

97.89%

Conclusion

Application of IAC Yokohama system of reporting breast cytopathology helps in easy categorization of breast FNA samples and it improves the efficacy of cytopathologist. It also provides better clarity to the clinicians in the management of the patient and can reduce unnecessary surgeries.

Conflicts of Interest

The authors declare that there are no conflicts of interest regarding the publication of this paper.

Source of Funding

None.

References

1 

G Agarwal P Ramakant Breast cancer care in India: The current scenario and the challenges for the futureBreast Care ( Basel)20083121710.1159/000115288

2 

A S Field F Schmitt P Vielh IAC standardized reporting of breast fine-needle aspiration biopsy cytologyActa Cytol201761136

3 

Field The International Academy of cytology Yokohama System for Reporting Breast FNA CytopathologyActa Cytologica201963425773

4 

Y H Yu W Wei J L Liu Diagnostic value of fine-needle aspiration biopsy for breast mass: a systematic review and meta-analysisBMC Cancer20121214160

5 

B S Ducatman H H Wang E Cibas B Ducatman BreastCytology: principles and clinical correlates, 4th Edn.Amsterdam: Elsevier2014

6 

J Dong A Ly R Arpin Q Ahmed E Brachtel Breast fine needle aspiration continues to be relevant in a large academic medical center: experience from Massachusetts General HospitalBreast Cancer Res Treat20161582297305

7 

A S Field AS Field MR Zarka Fine needle aspiration biopsy cytology of breast: a diagnostic approach based on pattern recognitionPractical Cytopathology: A Diagnostic Approach to Fine Needle Aspiration Biopsy’Amsterdam: Elsevier2017

8 

M Wang X He Y Chang G Sun L Thabane A sensitivity and specificity comparison of fine needle aspiration cytology and core needle biopsy in evaluation of suspicious breast lesions: a systematic review and meta-analysisBreast2017311576610.1016/j.breast.2016.11.009

9 

R S Hoda R N Arpin Iii R V Gottumukkala K S Hughes A Ly E F Brachtel Diagnostic value of fine-needle aspiration in male breast lesionsActa Cytol20196343192710.1159/000494486

10 

D Montezuma D Malheiros F Schmitt Breast FNAB cytology using the newly proposed IAC Yokohama System for Reporting Breast Cytopathology: the experience of a single institutionActa Cytol201910.1159/000492638

11 

S Wong M Rickard P Earls L Arnold B Bako A S Field The IAC Yokohama System for reporting breast FNAB cytology: a single institutional retrospective study of the application of the system and the impact of ROSEActa Cytol201910.1159/0005001991

12 

S A Badge A G Ovhal K Azad A T Meshram Study of fine-needle aspiration cytology of breast lumps in rural area of Bastar district ChhattisgarhMed J DY Patil Univ2017103394210.4103/MJDRDYPU.MJDRDYPU_250_16

13 

C H Sreedevi K Pushpalatha Correlative study of FNAC and histopathology for breast lesionsTrop J Path Micro2016232061110.17511/jopm.2016.i03.21

14 

D Montezuma D Malheiros F C Schmitt Breast Fine needle aspiration biopsy [7] cytology using the newly proposed IAC Yokohama system for reporting breast cytopathology: The experience of a single institutionActa Cytol20196342749

15 

M Apuroopa Application of Yokohama System for Reporting Breast Fine Needle Aspiration Cytology in Correlation with Histopathological and Radiological FindingsAnn Pathol Lab Med2020742115

16 

P V Kamatar Breast Fine needle Aspiration Biopsy Cytology Reporting using International Academy of Cytology Yokohama System Two Year Retrospective Study in Tertiary Care Centre in Southern IndiaNational J Lab Med201983PO013

17 

S Wong M Rickard P Earls L Arnold B Bako A S Field The International [8] Academy of Cytology Yokohama System for reporting breast fine needle aspiration biopsy cytopathology: A single institutional retrospective study of the application of the system categories and the impact of rapid onsite evaluationActa Cytol201963428091

18 

M Moschetta Comparison between fine needle aspiration cytology (FNAC) [9] and core needle biopsy (CNB) in the diagnosis of breast lesions G Chir- J Surg2014



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Article type

Original Article


Article page

237-242


Authors Details

Aka Sunitha, Sharath Chandra, Rambabu, GVRN Krishna Kanth


Article History

Received : 28-08-2021

Accepted : 28-10-2021

Available online : 02-12-2021


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