A retrospective analysis of 512 cases of breast fine needle aspiration cytology utilizing the recently proposed IAC Yokohama system for reporting breast cytopathology.

Introduction: Breast cancer affects 2.1 million women each year and is the most common cancer among females, followed by lung, colorectum, uterus, and cervix. Breast cancer accounted for 6,26,679 (6.6%) deaths in 2018. Breast cancer incidence is on the rise in every part of the globe, including developed countries. Fine Needle Aspiration Cytology (FNAC) shows high sensitivity, specificity, and accuracy in evaluation of breast lesions. FNAC is part of the triple test and is the gold standard for assessment. The new reporting system for breast FNAC, proposed by the International Academy of Cytology (IAC) Yokohama Breast Cytopathology System, has standardised the reporting system to categorise breast lesions and as unmasked the diagnostic dilemma faced by reporting cytopathologist. Aim: The study aimed to categorise the samples according to IAC Yokohama Breast Cytopathology System and assess the Risk of Malignancy (ROM) for each category and increase the diagnostic yield of breast FNAC. Materials and Methods: A retrospective cohort study included 1,467 breast FNAC cases, which were retrieved and reclassified based on the newly proposed IAC Yokohama System into five categories during January 2017-December 2018 in Kidwai Memorial Institute of Oncology (KMIO), Bangalore. Histopathology correlation was done, and the Risk of Malignancy (ROM) was assessed whenever possible. The study results were analysed using Microsoft excel 2007, sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), and accuracy ratios were calculated using the MedCalc diagnostic test evaluation calculator, keeping histologic diagnosis as the gold standard. Results: Re-categorisation of 1,467 cases was done according to the Yokohama breast cytopathology system as insufficient material, benign, atypical, suspicious for malignancy, and malignant. The histopathology diagnosis was available in 1,069 cases. The respective ROM for each category was, 7.6% for category 1 (Insufficient), 15.26% for category 2 (Benign), 65.38% for category 3 (Atypical), 83.33% for category 4 (Suspicious) and 99.18% for category 5 (Malignant). Considering malignant cases as positive, sensitivity-86.75%, specificity-97.32%, PPV-99.19%, NPV-66.06% and accuracy of 88.96% was deduced. Conclusion: It is recommended to incorporate the IAC Yokohama system to categorise breast cytopathology with uniform terminologies. This will help diagnose breast lesions more consistently and accurately, which in turn helps the clinician manage the disease and predict the ROM and the patient outcome.

Background: Worldwide breast malignancy is the major cause for mortality among women. Screening and early detection are crucial. Grey zones of uncertainty in cytomorphological differentiation of benign from malignant lesions can be overcome by Yokohama system of classification. Aims and Objectives: The objectives of this study are as follows: (1) To categorize Breast fine needle aspiration cytology (FNAC) samples according to the international academy of cytology (IAC) Yokohama system. (2) To assess the diagnostic accuracy, sensitivity, specificity, and risk of malignancy (ROM) for each category. Materials and Methods: A retrospective study of 144 breast FNAC cases with histopathological diagnosis was done based on Yokohama System from January 2018 to December 2020. ROM in each category was calculated. The study results were analyzed for sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) considering histological diagnosis as the gold standard. Results: Recategorization of 144 cases with histopathological diagnosis was done according to Yokohama system as insufficient material, benign, atypical, suspicious for malignancy, and malignant. The respective ROM for each category was, 7.6% for Category-1 (Insufficient), 15.26% for Category-2 (Benign), 65.38% for Category-3 (Atypical), 83.33% for Category-4 (Suspicious), and 99.18% for Category-5 (Malignant). Considering malignant cases as positive, sensitivity – 86.75%, specificity – 97.32%, PPV – 99.19%, NPV – 66.06%, and accuracy of 88.96% were deduced. Conclusion: Incorporation of IAC Yokohama system to categorize breast cytopathology using uniform terminologies provides diagnostic clarity, consistency, and accuracy in reporting, which in turn helps the clinician to predict the ROM and patient outcome.

Background: Worldwide breast malignancy is the major cause for mortality among women. Screening and early detection are crucial. Grey zones of uncertainty in cytomorphological differentiation of benign from malignant lesions can be overcome by Yokohama system of classification. Aims and Objectives: The objectives of this study are as follows: (1) To categorize Breast fine needle aspiration cytology (FNAC) samples according to the international academy of cytology (IAC) Yokohama system. (2) To assess the diagnostic accuracy, sensitivity, specificity, and risk of malignancy (ROM) for each category. Materials and Methods: A retrospective study of 144 breast FNAC cases with histopathological diagnosis was done based on Yokohama System from January 2018 to December 2020. ROM in each category was calculated. The study results were analyzed for sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) considering histological diagnosis as the gold standard. Results: Recategorization of 144 cases with histopathological diagnosis was done according to Yokohama system as insufficient material, benign, atypical, suspicious for malignancy, and malignant. The respective ROM for each category was, 7.6% for Category-1 (Insufficient), 15.26% for Category-2 (Benign), 65.38% for Category-3 (Atypical), 83.33% for Category-4 (Suspicious), and 99.18% for Category-5 (Malignant). Considering malignant cases as positive, sensitivity – 86.75%, specificity – 97.32%, PPV – 99.19%, NPV – 66.06%, and accuracy of 88.96% were deduced. Conclusion: Incorporation of IAC Yokohama system to categorize breast cytopathology using uniform terminologies provides diagnostic clarity, consistency, and accuracy in reporting, which in turn helps the clinician to predict the ROM and patient outcome.

The International Academy of Cytology (IAC) Yokohama System has developed a standardized system of reporting breast cytology. The current study aimed to apply the newly proposed YOKOHAMA classification system along with American College of Radiology Breast Imaging Reporting and Data system (ACR-BI-RADS) scoring to breast fine-needle aspiration cytology (FNAC) cases from the department archives and to assess the risk of malignancy (ROM) for each category. All breast FNACs done between January 20017 and June 2023 were reclassified according to the proposed IAC Yokohama reporting system. Histopathological correlation of the IAC Yokohama system and BI-RADS was done wherever available. A three-category approach was followed based on benign versus malignant, and sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated using histopathology as the gold standard. A total of 2130 breast FNACs were performed, of which 469 had a histopathological correlation and 892 had a BI-RADS correlation. The ROM for insufficient, benign, atypical, suspicious, and malignant categories were 29.16%, 3.28%, 28.57%, 100%, and 92.18%, respectively. Maximum specificity (96.8%) was observed when only malignant (cat A) and when both suspicious and malignant cases (Cat B) were taken as positive test results. Highest sensitivity (92.7%) was achieved when atypical, suspicious, and malignant cases were taken as positive test results (Cat C) and highest diagnostic accuracy (94.8%) was seen in category B. The sensitivity, specificity, PPV, NPV, and diagnostic accuracy of BI-ADS were 78.67%, 92%, 85.5%, 87.8%, and 87%, respectively. FNAC and imaging are the key modalities for diagnosing breast lesions. The IAC Yokohama system along with ACR-BI-RADS provides a simple yet useful approach for effectively categorizing the different breast lesions, which is useful for patient management and risk stratification.

Introduction:Recently the International Academy of Cytology (IAC) proposed a new Yokahama reporting system for breast fine-needle aspiration cytology (2019) in order to standardize reporting pattern and to link cytology reporting to management algorithms.Aims and Objectives:To categorize the samples according to the newly proposed IAC Yokahama reporting system of breast cytology and to assess diagnostic accuracy and corresponding risk of malignancy (ROM) for each category.Materials and Methods:This is a retrospective study of breast cytology cases done at Department of Pathology. The slides are retrieved from pathology archives and classified using a recently proposed IAC, Yokahama reporting system of breast cytology into five categories. The risk of malignancy, sensitivity, specificity, and diagnostic accuracy were estimated on the basis of the final histopathological diagnosis.Results:Of the 386 cases of breast FNAC, 226 (55.55%) had the corresponding histological diagnosis. The respective ROM for each category was 22.22% for category 1 (insufficient material), 5.32% for category 2 (benign), 26.31% for category 3 (atypical), 100% for category 4 (suspicious for malignancy), and 100 % category 5 (malignant). Malignant cases were considered only when positive tests, the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were 89.66%, 100%, 100%, 90.2%, and 94.69%, respectively.Conclusions:The present study showed statistically significant sensitivity, specificity, and diagnostic accuracy, especially with malignant cases. Hence, using the IAC Yokahama reporting system of breast cytology is effective to standardize the reporting in various institutes and provide clear guidelines to clinician for further management.

Standardized reporting of breast FNAC using the International Academy of Cytology Yokohama system and its comparison with histopathology: a cross-sectional study

Breast cytology is a significant component of the "Triple approach" for pre-operative diagnosis of breast lumps, the other two being clinical assessment and radiological imaging. The role of Fine needle aspiration cytology (FNAC) as a first line investigation in diagnosing breast lesions is well documented, however histopathology is the gold standard. Cyto-histopathological correlation is of great relevance and also increases precision.AIMS \& OBJECTIVES:The present study was conducted with the aim to categorize breast lesions according to the latest standardized reporting system proposed by International academy of cytologists (IAC) in 2016. Evaluation of diagnostic accuracy, sensitivity and specificity of FNAC in diagnosing breast lesions and cyto-histopathological correlation was planned. All FNAs of breast lesions over a period of 2 years were included in the study. The cases were grouped into five standardized categories proposed by the International academy of cytology: Category I (Insufficient material), Category II (Benign), Category III (Atypical, probably benign), Category IV (Suspicious, probably in situ or invasive) & Category V (Malignant) respectively. Specificity, sensitivity, diagnostic accuracy, negative and positive predictive value of FNAC were calculated and cyto-histopathological correlation assessed wherever possible. Out of 468 breast lesions reported on FNAC, the category wise distribution was - Category I, II, III, IV & V accounting for 23(4.9%), 342(73.07%), 7(1.5%), 11(2.35%) and 85(18.16%) respectively. Histopathology was performed in 331/468 cases with cyto histological concordance of 98.4% and a type agreement rate of 90.9%. The sensitivity, specificity, positive and negative predictive value and diagnostic accuracy was 98.90%, 99.16%, 97.82%, 99.58% and 99.09% respectively. FNAC is a simple, reliable, cost effective, first line diagnostic procedure for all breast lumps. In collaboration with physical examination and imaging studies (triple approach), FNAC is a highly sensitive diagnostic tool. Adopting a universally acceptable standardized reporting system for breast cytology can enhance the diagnostic accuracy of FNAC.

Background: Benign and malignant lesions of breast are one of the most common causes of palpable masses seen in women. Fine-needle aspiration cytology (FNAC) is the important modality of diagnosis of breast lumps. Previously, there were no uniform criteria for reporting breast FNAC. To overcome this problem, the newly designed system – International Academy of Cytology (IAC) – Yokohama system of reporting was implemented in 2016. The system offers a structured report to the patient. Aims and Objectives: This study aims to categorize breast FNAC according to the IAC – Yokohama system of reporting, to calculate the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of the test, and to analyze the cytomorphological spectrum of various breast lesions. Materials and Methods: A total of 210 patients presenting with breast lump in cytology section were subjected to FNAC using a 22 gauge needle under all aseptic precautions. Detailed clinical history was taken. All cytology and histopathology examination slides (wherever available) were thoroughly studied. FNAC smears were reported using IAC – Yokohama system of reporting. Results: In our study, benign category (C2) was most commonly seen in 73.33% of cases, followed by 10.48% of cases of atypical probably benign (C3), 2.38% of cases were reported as suspicious (C4), and 11.43% of cases were reported as malignant (C5). Cytohistopathological concordance was seen in 38 cases (88.4%) whereas five cases were reported as discordant. Sensitivity and specificity of the test for the diagnosis of malignancy were 81% and 100%, respectively. PPV was 100%. NPV was 90.90%. Diagnostic accuracy of the test was 93.47%. Conclusion: The newer IAC – Yokohama system of reporting of breast FNAC is simple, has clear diagnostic criteria hence boost up the confidence as well has uniformity of reporting by cytopathologist, and increases the understanding and uniformity in assessment by the attending clinician which help in improving the communication between the pathologist and the treating clinician.

Background: Benign and malignant lesions of breast are one of the most common causes of palpable masses seen in women. Fine-needle aspiration cytology (FNAC) is the important modality of diagnosis of breast lumps. Previously, there were no uniform criteria for reporting breast FNAC. To overcome this problem, the newly designed system – International Academy of Cytology (IAC) – Yokohama system of reporting was implemented in 2016. The system offers a structured report to the patient. Aims and Objectives: This study aims to categorize breast FNAC according to the IAC – Yokohama system of reporting, to calculate the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of the test, and to analyze the cytomorphological spectrum of various breast lesions. Materials and Methods: A total of 210 patients presenting with breast lump in cytology section were subjected to FNAC using a 22 gauge needle under all aseptic precautions. Detailed clinical history was taken. All cytology and histopathology examination slides (wherever available) were thoroughly studied. FNAC smears were reported using IAC – Yokohama system of reporting. Results: In our study, benign category (C2) was most commonly seen in 73.33% of cases, followed by 10.48% of cases of atypical probably benign (C3), 2.38% of cases were reported as suspicious (C4), and 11.43% of cases were reported as malignant (C5). Cytohistopathological concordance was seen in 38 cases (88.4%) whereas five cases were reported as discordant. Sensitivity and specificity of the test for the diagnosis of malignancy were 81% and 100%, respectively. PPV was 100%. NPV was 90.90%. Diagnostic accuracy of the test was 93.47%. Conclusion: The newer IAC – Yokohama system of reporting of breast FNAC is simple, has clear diagnostic criteria hence boost up the confidence as well has uniformity of reporting by cytopathologist, and increases the understanding and uniformity in assessment by the attending clinician which help in improving the communication between the pathologist and the treating clinician.

Background: Breast lumps pose a significant health concern globally, contributing to both illness and death. The International Academy of Cytology (IAC) Yokohama system has established a uniform method for reporting breast cytology, categorizing it into five groups: inadequate, benign, atypical, suspicious, and malignant. Aims and Objectives: This study primarily aimed to evaluate breast lesions using the IAC Yokohama System and compare the results with those of corresponding histopathological biopsies. Additionally, the study aimed to analyze the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of breast fine-needle aspiration cytology (FNAC) and determine the risk of malignancy associated with each category. Materials and Methods: In this study, 92 cases were analyzed and categorized according to the IAC Yokohama System. Sensitivity, specificity, PPV, NPV, diagnostic accuracy, and risk of malignancy were determined based on histopathological diagnosis, which was considered the reference standard. Results: Among the 92 breast FNACs, the risk of malignancy for the categories insufficient, benign, atypical, suspicious, and malignant were 0%, 0%, 18.75%, 100%, and 100%, respectively. The highest sensitivity (100%) was achieved when considering atypical, suspicious, and malignant cases as positive results. The specificity was highest (100%) when only malignant or both malignant and suspicious cases were considered positive results. The highest diagnostic accuracy (95.65%) was observed when including malignant and suspicious cases as positive results. Conclusion: Implementing the IAC Yokohama System for reporting breast cytopathology through structured reporting will enhance the quality, clarity, and reproducibility of reports among pathologists and clinicians, which would result in enhanced patient care and management.

Objective: We aimed to assess the risk of malignancy (ROM) and predictive values in prior breast cytology studies as a basis for the new International Academy of Cytology (IAC) Yokohama system for reporting breast fine-needle aspiration biopsy (FNAB) cytology, which classifies cytologic diagnoses into 5 categories: (1) insufficient material, (2) benign, (3) atypical, (4) suspicious of malignancy, and (5) malignant. Study Design: Publications between January 1, 1997, and December 31, 2017, that studied the performance characteristics of FNAB from palpable and nonpalpable breast masses were identified through the PubMed database. Data for number of total cases and cases within each diagnostic category, if available, were collected. Performance characteristics, including absolute sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and ROM for each category were recorded or, when possible, calculated. Results: The literature review resulted in a case cohort of 33,341 breast FNABs, drawn from 27 studies. Pooling these cases together, the ROM for insufficient material, benign, atypical, suspicious, and malignant were 30.3, 4.7, 51.5, 85.4, and 98.7%, respectively. The complete sensitivity and specificity were 96.3 and 98.8%, correspondingly. The PPV and NPV were 98.7 and 95.3%, correspondingly. The false-negative and false-positive rates were 3.7 and 1.0%, respectively. Conclusions: This meta-analysis demonstrates that the diagnostic categories of the new IAC Yokohama System each carry an implied ROM, which increases from the benign to malignant categories. This study also shows the high sensitivity and specificity of FNAB for breast lesions.

BackgroundThe International Academy of Cytology (I.A.C.) Yokohama System to report breast cytopathology can effectively categorize breast diseases into different cytological groups. Fine needle aspiration (FNAC) from the lesions in the breast has been regarded as a major method of diagnosing breast cancer, particularly in rural settings. The major purpose of this study was to validate the diagnostic accuracy of breast FNA utilizing the IAC Yokohama system in future endurances. Histopathological examination is considered the gold standard for diagnosing benign as well as malignant breast lesions and is compared with FNA results.Material and methodsResearch on patients getting a core-needle, incisional, or excisional biopsy of breast lesions between January 1st, 2021, and December 31st, 2021, was conducted at a tertiary care center in central India. 216 breast FNAs were recorded utilizing the IAC Yokohama system, and the most appropriate category was assigned for every case and correlated with histopathology to evaluate the effectiveness of IAC system.ResultsThe new "International Academy of Cytology (IAC) Yokohama system" was used to categorize 216 patients into five categories based on the cytologic diagnosis.Those were C1: insufficient material (8.7%), C2: benign (65.7%), C3: atypical (1.8%), C4: suspicious of malignancy (2.7%), and C5: malignant (20.8%). FNACs were associated with ancillary testing and histological diagnosis to examine diagnostic accuracy. The overall Specificity, sensitivity, negative predictive value, positive predictive value, and accuracy were calculated with the risk of malignancy.ConclusionWith high specificity and sensitivity for each type of situation, for all tumors, and for each analyzed BI-RADS category, the IAC Yokohama system provides excellent accuracy for breast FNA .

Objective: The International Academy of Cytology (IAC) Yokohama system was used to categorize breast lesions as the major goal of this investigation. Methods: Between January 2022 and March 2023, this study on breast fine needle aspiration cytology (FNAC) was carried out at a tertiary care facility in north India. This System of reporting breast cytopathology was used to classify a total of 100 patients. Histopathology correlation was available in 40 cases; Malignancy risk, sensitivity, specificity, and diagnostic precision were assessed. Results: Breast FNAC cytology was divided into five groups using the new IAC Yokohama system and discovered C1: Insufficient material (6%), C2: Benign type (72%), C3: Atypical type (05%), C4: Suspicious type of malignancy (06%), C5: Malignancy (11%). When histopathological reports were available, FNACs were connected with them. The likelihood of cancer, the precision, sensitivity, and specificity of the diagnosis were all calculated. Conclusion: The IAC Yokohama System for reporting breast cytopathology governs how breast FNAC are categorized, which offers an excellent method for reporting breast cytopathology with a uniform method of reporting and clear definition of each category as well as clear communication between pathologists and clinicians regarding the risk of malignancy and subsequent management.

Context: International academy of cytology (IAC) has established a standardized reporting system for fine-needle aspiration (FNA) cytology of breast lesions. They have introduced five categories (Code C1 to Code C5) for reporting breast cytology, each with clear descriptive term for the category, risk of malignancy (ROM) and a suggested management algorithm. Aim: Aims of the present study were to reclassify and correlate the breast FNA (IAC guidelines) with histopathological findings and to calculate the ROM for each category with special emphasis on assessing the diagnostic efficacy of cytological evaluation of code 3 and code 4. Materials and Methods: A 3 years' retrospective cross sectional study included 448 breast FNA samples that were reassessed and reclassified according to the IAC reporting system. The ROM for each category was analyzed. Results: The breast FNA samples were distributed in following categories as: C1 (insufficient material)− 1.78% (n = 8), C2 (benign) – 71.66% (n = 321), C3 (Atypical but benign) −10.81% (n = 45), C4 (Suspicious for malignancy) – 4.91% (n = 22), and C5 (Malignant)– 11.60% (n = 52). Out of the 448 cases, histopathological correlation was available for 205 cases. The ROM for each category was calculated as: 0% for C1, 2.04% for C2, 10.8% for C3, 85.71% for C4, and 100% for C5. The ability of C3 and C4 lesions to diagnose breast malignancy was statistically significant, P value 0.042 (P < 0.05). Conclusion: The IAC system for reporting of breast cytology effectively helps in accurate diagnosis and assessment of ROM for each category which helps in better patient management and further research.

Background: Breast cancer is steadily increasing worldwide. This study is based on application of recently proposed International Academy of cytology (IAC) Yokohama categorisation system of Breast cytology from C1 to C5. (C1-Insufficient material, C2-Benign, C3- Atypical, C4-Suspicious & C5-Malignant). We aim to categorize the breast lesions based on the above-mentioned categorization scheme (IAC, Yokohama 2016) along with histopathological correlation (wherever possible).Materials and Methods: This was a retrospective observational study conducted from January 2018 to December 2021 in the Department of Pathology of a tertiary care hospital involving coastal population. Ethical clearance was taken from institutional reviw committee. All patients with palpable breast lumps who had undergone FNAC were included in the study. Patient details and data were collected from the case records maintained in Department of Pathology. All quantitative parameters were described through descriptive statistics. Total scores were computed for all the risk factors. Sensitivity, specificity, Positive Predictive Value, Negative Predictive Value calculated. Risk of malignancy(ROM) was calculated for each category.Results: A total 200 patients, with age group ranging from 17 - 67 years with breast lesions were included in the study. C1 lesions were found in 5 cases, C2 in 152 cases, C3 in 11 cases, C4 in 4 cases, and C5 in 28 cases. Cytohistological correlation obtained in 94 cases with concordance noted in 89 cases and discordance in 5 cases.Conclusions: Breast FNAC cytology categorization according to IAC Yokohama system increases accuracy of diagnosis and helps clinician in appropriate patient management.