A Study of Fine Needle Aspiration Cytology of Breast Lesions in Females with Special Reference to IAC Standardized Reporting at a Tertiary Care Centre

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 and objective: The most common cancer of women worldwide is breast cancer and usually presents as a breast lump. Fine needle aspiration cytology and ultrasonography are two investigational techniques used to differentiate malignant breast lump from benign one. This study aimed to find out and compare the specificity, sensitivity, and predictive values of ultrasonography versus fine needle aspiration cytology for the diagnosis of malignant breast lump. Methods: Patients who presented with clinically palpable breast lump at the department of Surgery, Rizgary Teaching Hospital, Erbil, from October 2014 to March 2016, were included. The age of the study participants ranged from 15 to 56 years. The highest rate (28.9%) was among the age group 35-45 years. Breast abscess, cystic breast lumps, and recurrent lumps have been excluded. The ultrasonographic evaluation was done by using 7.5 MHz probe for all patients at the department of radiology and fine needle aspiration cytology at the department of histopathology. All the patients underwent excision of the lumps, and histopathological examination was done for tissues. Specificity, sensitivity, and predictive values of ultrasonography and fine needle aspiration cytology were estimated, taking the histopathological result as the gold standard. A comparison of values was made. Results: Ninety patients with 93 breast lumps were included in this study. Fine needle aspiration cytology reported 28 lumps as malignant lumps and 63 as benign, and two cases were indeterminate. Ultrasonography reported 27 cases as malignant, 54 as benign, and nine as indeterminate, while three breast lumps were failed to be detected. Sensitivity, specificity, positive and negative predictive values of ultrasonography and fine needle aspiration cytology in diagnosing malignant breast lump were 94.74%, 100%, 100%, 97.22%, and 90.48%, 100%, 100%, 95.24%,respectively. Conclusion: Ultrasonography and fine needle aspiration cytology are 100% specific in diagnosing malignant breast lesions. Although ultrasonography appears more sensitive than fine needle aspiration cytology, it has a higher percentage of the indeterminate report. Keywords: Fine needle aspiration cytology; Ultrasonography; Breast lumps.

Background: The International Academy of Cytology (IAC). Yokohama System has created a standardized method of describing breast cytology by grouping them into five categories: inadequate, benign, atypical, suspicious, and malignant. To validate the likelihood of cancer in the various categories, several investigations have been undertaken at various institutions as a mandate. Aim: The main objective of the research is to identify the accuracy of fine-needle aspiration cytology (FNAC) for breast lumps by the Yokohama system for reporting and its correlation with histopathology. Methodology: The present study was a retrospective research performed over 8 months. Fine-needle aspiration cytology (FANCs) for breast lumps are performed by the Yokohama system. Whenever accessible, histopathological diagnoses were also retrieved. Statistical Analysis Used: Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were estimated using a histological diagnosis as the gold standard concerning each of the five categories. Results: Out of 200 cases, 106 had histopathological concordance. Five categories: insufficient, benign, atypical, suspicious, and malignant of the IAC Yokohama system were 1.00%, 62.50%, 4.50%, 1.50%, and 30.50%, Category 1 (1%), Category 2 (62.5%), Category 3 (4.5%), Category 4 (1.5%), and Category 5 (30.5%). When malignant, suspicious, and unusual cases were taken into account as positive test findings, the highest level of sensitivity (90.60%) was attained. The maximum specificity (100%) was seen when only malignant patients were taken into account as positive test findings, but the highest diagnostic accuracy (96.22%) was shown when the malignant and suspect categories were taken into account as positive test results. Conclusion: FNAC using the Yokohama system for reporting is an accurate diagnostic tool for breast lumps. The system provides a standardized framework for reporting FNAC findings, and studies have reported high sensitivity and specificity rates for diagnosing breast lumps using FNAC. Therefore, FNAC can be used in conjunction with histomorphology to ensure accurate diagnosis and appropriate management of breast lumps.

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:International Academy of Cytology (IAC) has established a process to produce comprehensive and standardized approach to fine-needle aspiration cytology (FNAC) reporting. They have categorized the breast lesions in C1 to C5. (C1-Insufficient material, C2-Benign, C3- Atypical, C4-Suspicious & C5-Malignant).Aims and Objectives:The aim of study is to classify various breast lesions (C1 to C5) and to grade breast carcinoma on FNAC using Robinson's grading system which is then correlated with modified Bloom–Richardson grading.Materials and Methods:All routine FNAC for breast lump were included in the study during the period from Jan 2016 to Jan 2017. The study was conducted in the Department of pathology and lab medicine of a tertiary care hospital in central India.Results:A total 225 female patients were included in the study, with an age group ranging from 15 - 79 years, with lesions in breast were taken. C1 lesions were found in 3 cases, C2 in 186 cases, C3 in 13 cases, C4 in 4 cases, and C5 in 19 cases. Correlation of cytohistological grading was obtained in 108 cases.Conclusion:Cytological categorization based on IAC structured reporting will enhance the reproducibility of reports among pathologist & clinicians. With the comparison between cytohistological nuclear grading, the cytoprognostic scores will help in evaluating the aggressiveness of tumor, predicts histological grade and prognosis. It could be a useful parameter for selecting neo-adjuvant chemotherapy.

Introduction: Fine Needle Aspiration Cytology (FNAC) is a rapid, minimally invasive and cost-effective procedure with a high sensitivity rate of 92-95% and high Positive Predictive Value (PPV) approaching 100% for the diagnosis of breast malignancies. International Academy of Cytology (IAC) Yokohama system for reporting breast FNACs had been established in 2016 to bring consistency and uniformity of breast cytology reporting. Aim: To classify the breast lesions according to the IAC Yokohama system for cytological reporting of breast lesions. Materials and Methods: This was a retrospective six years study carried out in the Department of Pathology, Karpaga Vinayaga Institute of Medical Sciences, Chinnakolambakkam, Tamil Nadu, India. All females breast FNAC cases reported during the year January 2015 to December 2020 were included in the study according to the inclusion criteria. Relevant clinical and pathological data including the FNAC reports were retrieved from the medical records of the department. Corresponding FNAC smears stained with Haematoxylin and Eosin (H&E) and Papanicolaou stains were reviewed and double-checked with the FNAC reports. All those cases were grouped according to the IAC Yokohama System. Statistical analysis was carried out using Statistical Package for the Social Sciences (SPSS) version 23.0. Results: Of the total 381 female breast FNACs, majority (60%) of them belonged to the age group of 21-40 years. The predominant presenting symptom was palpable breast lump (73%) and Upper Outer Quadrant (UOQ) was involved in 65% of cases. Out of 381 cases, 297 (78%) were benign, 52 (13.6%) were malignant and 32 (8.4%) were inadequate for diagnosis. Total 73.8% cases belonged to “C2” category and fibroadenoma was the most prevalent lesion. Pearson Chi-square test showed highly significant association between patient’s age above 40 years and the risk of having a malignant breast lesion (p<0.0001). Conclusion: FNAC is an effective diagnostic modality for preoperative diagnosis of breast lesions thereby facilitating proper treatment at an early stage of the disease. Also adherence to the standardised cytological reporting system like IAC Yokohama system will ensure quality assurance across various institutions, thereby strengthening the healthcare services.

Breast cancer is the most prevalent cancer among women worldwide. In developing countries, fine needle aspiration cytology (FNAC) is commonly used for screening to reduce mortality rates. The International Academy of Cytology has established the Yokohama system to enhance diagnostic clarity and communication between pathologists and clinicians. A triple test approach, incorporating clinical evaluation, imaging, and FNAC, can further improve patient care for breast lesions and may enhance the Yokohama System's effectiveness. A prospective study about breast FNAC was done over a period of one year, from October 2022 to September 2023. The study involved patients with breast lesion referred for FNAC in the department of Pathology. The FNAC results were further classified using the Yokohama system for reporting breast cytopathology, 2016. The cytological findings were correlated with available histopathological results. In the study of 104 cases, 60 (57.7%) of whom had available histopathology results, breast lesions were categorized using the Yokohama system as: 7.7% insufficient, 47.1% benign, 26.9% atypical, 2.9% suspicious of malignancy, and 15.4% malignant. The risk of malignancy varied by category: 0% for category 1, 3.2% for category 2, 47% for category 3, and 100% for categories 4 and 5. The maximum sensitivity was 94.7% when considering atypical, suspicious, and malignant cases as positive. The highest specificity was 97.56% for malignant cases alone, while the best diagnostic accuracy was 83.3% when both malignant and suspicious cases were counted as positive. The Yokohama system effectively classified borderline lesions, facilitating early detection and improved management options. By integrating FNAC with standardized reporting, healthcare providers can make informed decisions, enhancing the diagnosis and treatment of breast lesions.

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.

The International Academy of Cytology (IAC) has developed a standardized approach for reporting the findings of breast fine-needle aspiration cytology (FNAC). Accordingly, there are five chief categories of breast lesions, C1 (insufficient material), C2 (benign), C3 (atypical), C4 (suspicious), and C5 (malignant). The prognostication and management of breast carcinoma can be performed readily on the basis of this classification system. The aim of this study was to classify various breast lesions into one of the above-named categories and to further grade the C5 lesions specifically using the Robinson system. The latter grades were then correlated with modified Scarff-Bloom-Richardson (SBR) grades. This retrospective study was undertaken in the pathology department of a hospital located in the urban part of the city of Bangalore. All FNAC procedures performed on breast lumps spanning the year 2020 were included in the study. A total of 205 breast lesions was classified according to the IAC guidelines into C1 (6 cases, 2.9%), C2 (151 cases, 73.7%), C3 (13 cases, 6.3%), C4 (5 cases, 2.5%), and C5 (30 cases, 14.6%) groups. The C5 cases were further graded using Robinson's system. The latter showed a significant correlation with the SBR system (concordance=83.3%, Spearman correlation=0.746, Kendall's tau-b=0.736, kappa=0.661, standard error=0.095, p≤.001). A standardized approach for FNAC reporting of breast lesions, as advocated for by the IAC, improves the quality and clarity of the reports and assures diagnostic reproducibility on a global scale. Further, the cytological grading of C5 lesions provides reliable cyto-prognostic scores that can help assess a tumor's aggressiveness and predict its histological grade.

The current practice of “Fine Needle Aspiration Cytology (FNAC) has established itself as an important modality in the diagnosis and management of superficial and deep seated lesions throughout the body. With this wide employment of FNAC, the cytopathologists play a pivotal role in the management and therapeutic decisions that are based on the diagnosis of these limited FNAC samples. Furthermore, the use of FNAC samples for biomarker research is advancing rapidly and is being widely investigated and applied for the treatment and prognostic purposes. In this special issue, we have made an attempt to provide a “flavor” of the current practice of FNAC with an emphasis on correlation of tissue biopsies with PET results, FNAC of breast, liver, pulmonary, and head and neck lesions. Similarly, the use of FNAC in the diagnosis of Langerhans cell histiocytosis, neuritic leprosy, and granulomatous inflammation is also discussed. With the increasing use of image-assisted FNAC, pathologists are now an integral part in the diagnosis and management of the deep seated lesions. In lieu of this, it has become important for the pathologists to be aware of the limitations of different imaging techniques. The paper on the correlation of tissue biopsies with PET results discusses the limitations of an increased SUV value on PET scan. The use of fine needle aspiration cytology has been proven to give fast, economical, and valuable diagnosis of palpable breast lumps. In this issue, the role of FNAC in the evaluation of breast lump in a high patient volume center is addressed with emphasis on the importance of skill and training for both pathologists and technicians to prevent suboptimal sampling, thus, increasing the reliability of the procedure. Another important but not commonly discussed aspect of breast FNAC—the nonmalignant categories—is also addressed, with a review of the cytomorphology of benign breast lumps, some of which could be mistaken for malignancy due to the diaphanous appearance and overlapping cytologic features. The false negative and false positive FNAC is further discussed in detail so as to avert misinterpretation. These provide practical information for readers when dealing with FNAC of breast lesions. The paper on liver FNAC covers various aspects and discusses the role of FNAC in liver lesions. There is an active debate about the preoperative/pretransplantation diagnostic role of FNAC of hepatocellular carcinoma (HCC) and precursor lesions, especially in the face of advances in dynamic imaging techniques. New trends in personalized molecular targeted therapy require better characterization and prediction of HCC behavior. FNAC biopsy technique is still the most minimally invasive approach for the procurement of tumor and peritumoral tissue for molecular studies. Thus, in the near future, hepatic FNAC is likely to become a point of care in the management of HCC patients, especially inoperable cases. In the current era of personalized medicine, the FNAC diagnosis of nonsmall cell carcinoma for a pulmonary nodule is no longer considered an adequate diagnosis. Pathologists are often required to further subclassify these in to adenocarcinoma and squamous cell carcinoma. With the increasing use of image-assisted FNAC including endobronchial ultrasound guided FNAC (EBUS-FNA), cytologic or small biopsy material has become the only form of tissue available for diagnosis. The paper on FNAC of pulmonary lesions reviews the current concepts in the suitability and accuracy of FNAC in lung cancers including diagnosis, classification, use of ancillary techniques, and prognostic marker assessment. FNAC is a valuable technique in the workup of nodules and masses arising within the head and neck region. It is primarily utilized to confirm or exclude the diagnosis of malignancy involving head and neck organs especially lymph nodes, thyroid, and salivary glands. It has been shown that FNAC of salivary gland lesions is a valuable way to preoperatively assess lesional tissue, determine the need for surgical intervention, and assist in planning the appropriate surgical approach prior to resection. In this issue, the manuscript on cytologic diagnosis of mucoepidermoid carcinoma discusses the role of FNAC in the diagnosis of mucoepidermoid carcinoma (MEC), the common malignant tumor affecting parotid gland. In addition, it also brings forth how the rare and recently described oncocytic variant can pose problems in the diagnosis of MEC. In conclusion, this special issue includes a potpourri of topics which provides a thoughtful glimpse into various techniques, diagnostic ability, and limitations of the current practice of FNAC. Darshana Jhala Aileen Wee Gary Tse Zubair Baloch

Background: Breast lumps constitute a significant proportion of surgical cases in both developed and developing countries. Fine Needle Aspiration Cytology (FNAC) is a simple, minimally invasive, cost effective, outpatient based and a rapid diagnostic method for breast lesions. The aim of the present study was to study the cytological spectrum, cytohistological correlation and diagnostic accuracy of aspiration cytology (FNAC) in palpable breast lesions. Material and Methods: This was a prospective study done in the department of Pathology, L.N. medical college, Bhopal, India from January 2016 to December 2016. FNAC of 300 cases of palpable breast lesions were done and reported by expert pathologist. The histopathological specimen when available were reported by other pathologist without prior knowledge. Sensitivity, specificity and accuracy of FNA diagnosis were then analyzed. Results: A total of 300 cases of breast lesion were diagnosed on FNA, out of them histopathological correlation was available for 150 cases. Benign breast lesions are more common in younger patients in 11-30 age group and Malignant breast lesion are more common in old age group patients of 41-60 yrs age group. Benign breast lesions were found in 215 cases (71.66%); among which fibroadenoma (41%) was the commonest lesion observed. Malignancy was observed in 63 cases (21%); among them, Ductal carcinoma was the predominant lesion (17.66%). The sensitivity, specificity and diagnostic accuracy of FNAC for malignant lesion is found to be 98.3%, 98.9% and 98.7% respectively. Conclusion: FNAC is an effective and valid tool as first line diagnostic modality in preoperative diagnosis of malignant and benign breast lesions.

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.

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.

Breast cancer is the most common cancer of women worldwide and usually presents as lump in the breast. Ultrasonography and Fine Needle Aspiration Cytology (FNAC) are two investigational tools often used to differentiate malignant breast lump from benign one. Aims and Objects: To find out and compare the sensitivity, specificity and predictive values of ultrasonography and FNAC in diagnosing malignant breast lump. Patients who presented with clinically palpable breast lump at the department of Surgery, RIMS, India, from September, 2010 to August, 2012, were included. Recurrent lumps, breast abscess and cystic breast lumps were excluded. All the patients underwent Ultrasonographic evaluation using 7.5 MHz probe (©SIEMENS, Sonoline Versa Plus) at the department of Radiodiagnosis, RIMS and FNAC at the department of Pathology, RIMS. All the patients underwent excision of the lumps and tissues were sent for Histopathological examination. Sensitivity, specificity and predictive values of ultrasonography and FNAC were calculated taking Histopathological result as the gold standard. Values were compared. Sixty patients with 62 breast lumps (40 benign and 22 malignant) were included. FNAC reported 42 lumps as benign and 19 as malignant and was indeterminate in 1 case. Ultrasonography reported 36 cases as benign, 18 as malignant and 6 as indeterminate; it failed to detect breast lump in 2 cases. Sensitivity, specificity, positive and negative predictive values of ultrasonography and FNAC in diagnosing malignant breast lump were respectively 94.74%, 100%, 100%, 97.22% and 90.48%, 100%, 100%, 95.24%. Ultrasonography and FNAC are 100% specific in diagnosing malignant breast lesion. Although Ultrasonography appears more sensitive than FNAC, the percentage of indeterminate report is higher with Ultrasonography.