IAC standardized reporting of breast fine-needle aspiration cytology, Yokohama 2016: A critical appraisal over a 2 year period.

For patients who present to clinicians with palpable breast lesions, the triple test: (physical examination, mammography and fine-needle aspiration cytology) can be employed to provide accurate diagnosis. In this study, the sensitivity, specificity and predictive values of triple test components were studied separately and in combination. During the study period (from January 1998 to December 1999), 140 patients with palpable breast masses were subjected to all components of the triple test followed by confirmatory open biopsy. Physical examination showed 82.6% sensitivity, 97.3% specificity and 86.4% positive predictive value. Mammography showed 87.5% sensitivity, 97.3% specificity and 87.5% positive predictive value and fine-needle aspiration cytology (FNAC) showed 91.7% sensitivity, 100% specificity and 100% positive predictive value in concordant cases (elements had either all malignant or all benign results). The triple test was 100% accurate in the diagnosis of palpable breast lesions when all three elements were concordant. Based on these results, we recommend elimination of the confirmatory open biopsy, which will result in reduced expenses and morbidity compared with open biopsy.

To determine the diagnostic accuracy of fine-needle aspiration cytology (FNAC) in liver masses to isolate malignant from benign tumours and hepatocellular carcinoma (HCC) from metastatic tumours. Cross-sectional, observational. Department of Histopathology, Combined Military Hospital, Peshawar, from June 2004 to June 2005. All the patients with liver masses confirmed by ultrasonography, irrespective of age and gender, were included. Patients with inflammatory lesions were excluded from the study. Selected patients underwent fine-needle aspiration under ultrasound guidance followed by needle biopsy. The cytological slides were stained by haematoxylin and eosin (H & E) stain, while Papanicolaou's stain was employed in selective cases. Needle biopsy fragments were fixed in formalin followed by paraffin embedding and staining with H and E stain. Sensitivity and specificity of FNAC in the diagnosis of liver masses was determined using histological diagnosis on liver biopsy as gold standard. There were one hundred subjects. The mean age at presentation was 55 + or - 12 years with male to female ratio of 1.7:1. Cytological diagnosis in 19 cases was benign/non-neoplastic and 81 was malignant. Out of the latter, 49 (60.49%) were HCC and 32 (39.51%) were metastatic tumours on cytology. The overall sensitivity, specificity and accuracy of FNAC in the diagnosis of malignant lesions was 95.2%, 100% and 96% respectively using histological diagnosis on liver biopsy as gold standard. Sensitivity of FNAC to differentiate HCC from metastatic tumours in liver was 96% while specificity was 100% having a diagnostic accuracy of 97.5%. The discrepancy in cyto-histological comparison was mainly seen in welldifferentiated and poorly-differentiated HCCs. FNAC of the liver masses is a simple, safe, accurate, economical screening test without significant morbiditythat can be used to identify the vast majority of hepatic neoplasms of primary or metastatic nature with high sensitivity, specificity and diagnostic accuracy.

BackgroundBreast cancer is the most frequently diagnosed cancer in women worldwide, accounting for more than one in ten new cancer cases each year. It ranks as the second leading cause of cancer-related mortality among women. The majority of patients present with palpable breast lumps. Effective surgical management of breast cancer largely depends on accurate preoperative pathological diagnosis. This study evaluates the diagnostic accuracy and prognostic implications of fine-needle aspiration cytology (FNAC) compared with core needle biopsy (CNB) in breast carcinoma.ObjectivesThe objectives of this study are to assess the sensitivity and specificity of FNAC and CNB, to compare the diagnostic accuracy of FNAC and CNB against histopathological findings from gross specimens in the evaluation of breast lumps, and to identify and examine the limitations associated with both FNAC and CNB procedures.Materials and methodsThis study included female patients presenting with clinically suspicious palpable breast lumps at the General Surgery OPD of Bankura Sammilani Medical College and Hospital, Bankura. All patients underwent FNAC followed by CNB. The cytological and CNB diagnoses were compared with the final pathological diagnosis obtained from excisional biopsy.ResultsThe study included 44 female patients aged 20 to 70 years. The most common age group for breast carcinoma was 50-59 years (36.36%). Malignancy was diagnosed in 75% of cases (33/44), with right breast involvement (65%) being more common than the left. The upper outer quadrant (59%) was the most frequently affected area. Among the 33 confirmed malignant cases, 69.70% had lesions larger than 5 cm. FNAC demonstrated a sensitivity of 93.93%, specificity of 100%, positive predictive value (PPV) of 100%, negative predictive value (NPV) of 84.61%, and diagnostic accuracy of 95.45%. CNB showed a sensitivity of 96.97%, specificity of 100%, PPV of 100%, NPV of 91.67%, and diagnostic accuracy of 97.73%. Both methods correlated significantly with the final histopathology results (p < 0.05). FNAC identified ductal carcinoma in 93.55% of cases, while CNB identified it in 96.77%.ConclusionCNB provides additional information on receptor status but is more resource-intensive. FNAC remains a cost-effective and time-efficient first-line diagnostic tool, especially in resource-constrained settings like rural India. FNAC should be employed for initial diagnosis, with CNB reserved for cases requiring further clarification.

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 correlate cytological findings with histopathological findings and to determine the accuracy of FNAC in the diagnosis of breast lesions. A total of 222 breast aspirates were studied. Histo-cytopathological correlations were obtained in 91 cases. All the aspirates were stained with Haematoxylin and Eosin (H andE) stain. Among 222 patients, 217 were females and 5 were males. Benign breast lesions were found in 144 cases (64.87%); among which fibroadenoma (30.18%) was the commonest lesion which was observed. Malignancy was observed in 69 cases (31.08%); among them, ductal carcinoma was the predominant lesion (29.28%) which was seen. Histopathological confirmations were obtained in 90 cases out of 91 cases in which histo-cytopathological corrections were possible. All 45 malignant aspirates were confirmed by histopathology. Benign reports were confirmed in 45 out of 46 cases by doing histological examinations; except one case which was diagnosed as malignant by studying its histopathology. Sensitivity and specificity of FNAC in breast lesions were reported to be 97.82% and 100% respectively, with 100% positive predictive value and 97.85% negative predictive value. Diagnostic accuracy of FNAC in the present study was found to be 98.90%. It is important to remember that a negative FNAC of a breast lesion does not preclude the diagnosis of a carcinoma, particularly in presence of a clinical suspicion of malignancy and/or an abnormal mammogram.

Objective: To compare sensitivity and specificity of FNAC with Tru-cut biopsy diagnosis of breast lump patients. Material and Methods: It was a cross sectional study conducted at surgical department of Gulab Devi Teaching Hospital Lahore from January 2022 to December 2022. Atotal of 122 patients presented in surgical OPD with complaints of breast lump of size between 2cm to 4 cm were included in the study with their consent. All these patients underwent FNAC, true cut biopsy and excisional biopsy. Sensitivity and specificity of both FNAC and true cut were calculated. Results: Mean age of patients included in this study was 35.4 ± 14.6 years. The sensitivity and specificity of FNAC in benign breast diseases was 98.2% and 74.2% respectively while in malignant diseases it was 72.7% and 98.8% respectively (p-value 0.00). The sensitivity and specificity of Tru-cut in breast diseases was 100% and 97.1% respectively while in malignant diseases it was 97% and 98.2% respectively (p-value 0.00). Conclusion: Breast lump is more common in females as compared to males. Breast carcinoma is more common in old females and benign breast diseases is common among young females. Tru-cut biopsy is better than FNAC in diagnosis of both benign and malignant lesions of breast lumps.

Thyroid disease affects about 5% of the World's population. Fine Needle Aspiration Cytology (FNAC) helps in planning extent of surgery. In some studies, FNAC has been found to have a low accuracy for malignancy. To estimate the sensitivity and specificity of FNAC in detecting malignancy for thyroid disease using histopathology as the gold standard. Patients who underwent clinical and laboratory evaluation and thyroidectomy at Mulago National Referral hospital and the Pathology department of Makerere University College of Health Sciences were consecutively recruited over a four months period. Analysis using STATA version 10 focused on sensitivity, specificity and accuracy of FNAC in detecting malignancy. In total, 99 patients were recruited, the F:M ratio was 15.5:1 and median age was 42 years (IQR 34-50). The median duration of symptoms was 364 weeks (IQR 104-986). The proportion of patients with malignancy was 13.3% with papillary thyroid carcinoma being the most predominant type and colloid goiter was the most predominant benign thyroid disease. The sensitivity was 61.5% and specificity 89.5%. This study revealed high specificity and low sensitivity of Fine Needle Aspiration Cytology (FNAC) at detecting malignancy in thyroid nodules.

Fine needle aspiration biopsy in pediatric space-occupying lesions of liver: a retrospective study evaluating its role and diagnostic efficacy

Background &amp; Objective: Fine-needle aspiration cytology (FNAC) is frequently used to evaluate a breast lump, for it is safe, reliable, and time saving outdoor procedure for evaluation of breast lumps. However, in recent times, the diagnosis of breast lesions has mostly become dependent on Tru-cut biopsies with a gradual reduction in the rate of performing fine-needle aspiration cytology (FNAC). The present study was undertaken to compare the diagnostic accuracy of Tru-cut Biopsy and Fine Needle Aspiration Cytology (FNAC) in the evaluation of a clinically palpable breast lump.&#x0D; Methods: This cross-sectional study was conducted in the in Department of Surgery, Rajshahi Medical College &amp; Hospital, Rajshahi, Bangladesh over a period of one year from July 2019 to June 2020. A total of 60 women with clinically palpable breast lumps were consecutively included in the study. All patients underwent FNAC and Tru-cut Biopsy to make a provisional (clinical) diagnosis of breast lump followed by histopathology of the excision biopsy taken during surgery to confirm the diagnosis. The diagnostic accuracies (sensitivity, specificity, positive and negative predictive values) of the two diagnostic modalities (FNAC and Tr-cut Biopsy) were then judged by comparing them with the histopathological diagnosis of the excision biopsy.&#x0D; Result: In the present study majority (86.7%) of the lesions was malignant in terms of histopathology with almost all being infiltrating carcinoma (98%). Only 8(13.3%) cases were benign breast lesions and all of them were fibroadenoma. While Tru-cut or Core-needle biopsy (CNB) diagnosed 85% of the lesions as malignant, FNAC diagnosed 65% of lesions as malignant. The sensitivity of CNB was observed to be 98.1% and its specificity was 100%. In contrast, the sensitivity of FNAC was much lower (65%), although its specificity was comparable to that of CNB (100%). While the overall diagnostic accuracy of CNB was 98.3%, that of FNAC was 78.3%. The test of agreement between Tru-cut biopsy and FNAC using kappa-statistics showed that the two diagnostic modalities had moderate agreement in differentiating malignant breast tumours from the benign ones (k-value = 0.494, p &lt; 0.001).&#x0D; Conclusion: The study concluded that Tru-cut biopsy and FNAC both are hundred percent specific in excluding a benign breast lesion. However, the sensitivity of FNAC is much lower compared to that of CNB with overall diagnostic accuracy of Tru-cut biopsy being much higher than FNAC.&#x0D; Ibrahim Card Med J 2021; 11 (1): 21-27

Background: Salivary gland tumors are an uncommon entity and its histopathology is highly varied due to heterogeneous cellular composition. The role of the preoperative fine-needle aspiration cytology (FNAC) remains controversial. The purpose of this study is to compare the cytologic findings of salivary gland lesions with the histologic diagnoses, in order to assess the usefulness and accuracy of fine-needle aspiration cytology in the diagnosis of parotid gland tumors. Methods: A retrospective study was performed, regarding patients (n = 65) submitted to surgery for the treatment of parotid gland disease, who had performed preoperative FNAC, in our department between 2002 and 2012. A histologic diagnosis was considered as the gold standard for the assessment of sensitivity and specificity of FNAC. A cytohistologic correlation was done and appropriate statistical tests were applied. Results: Concordance between FNAC and histological specimen analysis was 78%. FNAC specificity was 82% and sensitivity was 71%. Positive and negative predictive values were 65% and 86% and positive likelihood ratio and negative likelihood ratio were 3.92 and 0.35, respectively. The diagnostic accuracy for this test was 78%. Conclusion: Preoperative FNAC of parotid lesions is reasonably accurate and useful in diagnosing benign from malignant lesions and in planning appropriate approach for treatment.

Background: Palpable breast lesions are one of the most common presentations in general and oncological surgical practice. Fine-needle aspiration cytology (FNAC) is an ideal initial diagnostic modality in the diagnosis of palpable breast lesions and to confirm the pre-operative diagnosis of malignant breast lesions. Materials and Methods: This prospective study was done from March 2019 to December 2020. One hundred and eighty patients with palpable breast lumps who came to the outpatient department were investigated and operated on at our tertiary care centre. All patients were informed about the study, prior consent was taken, proper history was recorded and FNAC and post-operative Histopathological Examination (HPE) reports were recorded, tabulated and compared. The sensitivity, specificity, positive predictive value (PPV), negative predictive value and accuracy of FNAC compared to the gold standard histopathology were calculated. Results: The sensitivity of FNAC was 98.6% in benign lesions and 95% in malignant lesions in the present study. The specificity and PPV of benign cases were 95% and 98.6%, respectively. The specificity and PPV of malignant lesions in FNAC were 98.6% and 95%, respectively. The diagnostic accuracy of FNAC in our study was 97.80%. Conclusion: We conclude that FNAC is a very important preliminary diagnostic test in palpable breast lumps, and if done by expert hands, the results show a high degree of correlation with the final histopathology report.

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.

Introduction: Fine Needle Aspiration Cytology (FNAC) is considered as a simple, minimally invasive, cost effective, readily repeated and quick to perform procedure in the outpatient department with excellent patient compliance. High sensitivity and specificity of FNAC has made it as an initial diagnostic in thyroid swellings. However, it has its own limitation as in cases of lymphoma and follicular adenoma. Methods: Prospective, observational study including total of 37 patients (7 males and 30 females) with thyroid swellings who presented in department ORL-HNS, National Academy of Medical Sciences (NAMS), Bir Hospital, Kathmandu, Nepal were evaluated pre-operatively with FNAC from August 2017 to July 2018 and these findings were compared with histopathology observations following thyroidectomy. Results: Out of 37 patients evaluated, 16 (43.20%) were found to have malignancy on histopathological examination (HPE). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of FNAC was 61.5%, 94.4%, 88.9%, 77.3% and 80.6% respectively. Conclusion: We can conclude that FNAC is a simple, safe and cost-effective diagnostic modality in the investigation of thyroid swellings with high specificity, PPV and accuracy.

Conclusion: The accuracy and sensitivity of fine-needle aspiration cytology (FNAC) in this analysis were not satisfactory, and the false-negative rate seemed to be higher than for parotid tumours. The possibility of low-grade malignancy should be considered in the surgical treatment of accessory parotid gland (APG) tumours, even if the preoperative results of FNAC suggest that the tumour is benign. Objectives: Little is known about the usefulness of FNAC in the preoperative evaluation of APG tumours, probably due to the paucity of APG tumour cases. We examined the usefulness of FNAC in the detection of malignant APG tumours. Methods: We conducted a retrospective analysis of 3 cases from our hospital, along with 18 previously reported Japanese cases. We compared the preoperative FNAC results with postoperative histopathological diagnoses of APG tumours and evaluated the accuracy, sensitivity, specificity and false-negative rates of FNAC in detecting malignant APG tumours. Results: There were four false-negative cases (19.0%), three of mucoepidermoid carcinomas and one of malignant lymphoma. One false-positive result was noted in the case of a myoepithelioma, which was cytologically diagnosed as suspected adenoid cystic carcinoma. The accuracy, sensitivity and specificity of FNAC in detecting malignant tumours were 76.2%, 60.0% and 90.9%, respectively.

Fine-needle aspiration cytology (FNAC) is an established, highly accurate method for diagnosing breast lesions. However, in recent years there has been increased use of core biopsy (CB) in this setting. The aim of this study was to evaluate the accuracy of FNAC and compare the quality assessment parameters of FNAC and CB in palpable and nonpalpable breast lesions. Data regarding FNAC, CB, and excision biopsy (EB) diagnoses were retrieved from the archives of our department. A total of 4,367 FNAC samples from the years 1999-2001 was reviewed. Of these, corresponding histology results were available for 1,275 lesions, of which 1,248 were primary breast epithelial lesions (788 EB, 199 CB, 261 EB+CB). All cases were analyzed for sensitivity and specificity of FNAC. Cases with both FNAC and CB were compared and quality assessment parameters were calculated using the methodology detailed in the National Health Service Breast Screening Program guidelines. High specificity and sensitivity, as calculated for satisfactory specimens, were achieved with the use of both FNAC and CB. False-positive and false-negative diagnoses were seen in 7/404 (1.7%) and 45/635 (7.1%) of biopsy-proven specimens sampled by FNAC. The corresponding values for CB were 0% and 5.7%, respectively. Inadequate sampling (15.1%) with use of FNAC was particularly seen in collagenous lesions and in submitted specimens sampled by physicians lacking experience with the FNAC procedure. FNAC is a valuable method, although moderately less sensitive than CB. CB is the preferred method for preoperative diagnosis when sampling FNAC provides scarce material and suspicion of a fibrotic and collagenous lesion such as lobular carcinoma and radial scar arises. FNAC is most accurate when experienced cytologists are available and when immediate assessment by professionals is performed for evaluation of material adequacy, so that additional aspirations can be done when needed.

OP149: Diagnostic accuracy of fine-needle aspiration cytology in parotid tumors