International Academy Of Cytology Yokohama System Research Articles

Cytomorphological spectrum of breast fine needle aspiration cytology using the International Academy of Cytology Yokohama System and evaluation of associated risk of malignancy–A retrospective study in a tertiary care cente

BackgroundFine-needle aspiration cytology (FNAC) of the breast is a well-established technique that aids in the preoperative identification and differentiation between nonneoplastic and neoplastic breast lesions. Breast lesions can be efficiently categorized into different cytological groups using the International Academy of Cytology (IAC) Yokohama System. The aim of this study was to classify breast lesions based on the proposed Yokohama system of reporting breast cytology and identify the need for a unified system of reporting breast lesions.Materials and methodsThis retrospective descriptive study was performed in the Department of Pathology, Government Medical College, Datia, M.P. from January 2019 to June 2023. A total of 762 FNAC slides reported during this period were retrieved, re-examined and reclassified according to the IAC Yokohama System. Histopathological diagnoses were also retrieved and correlated with the cytological findings wherever available.ResultsIn the present study, a total of 762 smears of breast fine needle aspirations were included and categorized using the IAC Yokohama System. There were 3.8% cases (29/762) in the C1 category (insufficient), 71.6% cases (545/762) in the C2 category (benign), 6.3% cases (48/762) in the C3 category (atypical), 3.1% cases (24/762) in the C4 category (suspicious for malignancy) and 15.2% (116/762) cases in the C5 category (malignant).ConclusionFNAC is a reliable diagnostic technique for the evaluation and management of breast lesions prior to surgery. Implementing the IAC Yokohama System for reporting breast cytopathology enhances the accuracy of diagnosing breast lesions, reduces missed diagnoses, and offers reliable estimates of risk of malignancy. Adopting the Yokohama system is a crucial first step in boosting the overall effectiveness of breast cytology reporting among clinicians and pathologists, which will ultimately lead to improved communication and patient care.

RAPID ON-SITE EVALUATION AND MICRONUCLEUS SCORING IN BREAST LESIONS FINE NEEDLE ASPIRATION CYTOPATHOLOGY BY NEW IAC YOKOHAMA SYSTEM OF REPORTING

Objective: The objective of the study is to report all fine needle aspiration cytopathology (FNAC) cases of lump breast as per New Yokohama classification 2016, to highlight the importance of rapid onsite evaluation (ROSE) in breast cytology at the time of FNAC, and to assess the relationship between micronucleus (MN) scoring and various breast lesions in cytology. Methods: The study was conducted on 70 patients with breast lumps in the Department of Pathology in Government Medical College, Patiala, and comprised evaluation of ROSE and MN scoring in breast FNAC by the use of New Yokohama system of reporting. Results: On ROSE, 11 out of 70 patients were categorized under category I according to the Yokohama system of reporting and on the same sitting with repeat FNAC after performing the ROSE; nine cases were upgraded for cytological reporting and two remained in category I. According to as per the International Academy of Cytology (IAC) Yokohama system of reporting (2016) cases were categorized as category I – 2 (2.9%), category II – 46 (65.7%), category III – 7 (10.1%), category IV – 5 (7.1%), and category V – 10 (14.2%). In MN scoring, MN with the highest score of 14–17/1000 epithelial cells was in category V (malignant), and the lowest score was 0–1/1000 epithelial cells in category II (benign). Conclusion: ROSE is an easy, safe, and cost-effective method. IAC Yokohama system for reporting (2016) provides a comprehensive way of categorizing various breast lesions on FNAC with clinical correlation. MN score is a good biomarker in differentiating benign, atypical, and malignant breast lesions.

Diagnostic Accuracy of Fine-Needle Aspiration Cytology for Breast Lump by Yokohama System for Reporting and Its Correlation with Histomorphology

Abstract 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.

FNAC as preoperative diagnostic tool for neoplastic and non-neoplastic breast lesions with special reference to IAC standardised reporting in Coastal population - A teaching hospital experience

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). 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. 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. Breast FNAC cytology categorization according to IAC Yokohama system increases accuracy of diagnosis and helps clinician in appropriate patient management.

A RETROSPECTIVE COHORT STUDY IN AN INDIAN TERTIARY CARE HOSPITAL ON BREAST LESION CLASSIFICATION BY THE IAC YOKOHAMA SYSTEM USING FNAC

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.

Cytological Evaluation of Fine Needle Aspiration of Breast Lesions Using IAC Yokohama Classification System for Reporting Breast Cytopathology

Introduction: Breast cancer is rapidly emerging as the leading cause of cancer in Indian women. Cytopathology and histopathology services are required to tackle this growing burden. The use of International Academy of Cytology (IAC) Yokohama Reporting System of breast cytology by classifying them into five categories insufficient, benign, atypical, suspicious and malignant. (IAC) Yokohama Reporting System offers structured protocols, are expected to improve breast cytopathology reporting. Objective : The main objectives of our study were to classify breast fine needle aspirates according to the IAC Yokohama system and assess the risk of malignancy, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. Methodology: All breast FNAs done in the above period were retrieved and classified into five categories according to the Yokohama system. Histopathological diagnosis was also retrieved wherever available. Results: The new “International Academy of Cytology (IAC) Yokohama system” was used to categorize 205 patients into five categories based on the cytologic diagnosis. That C1: insucient material (7.8%), C2: benign (64.3%), C3: atypical (7.3%), C4: suspicious of malignancy (7.8%), and C5: malignant (12.6%). Risk of malignancy (ROM) was calculated which was 100% in Yokohama category I, IV and V. In category II ROM was 00% and in category III ROM was 55.5%. FNAC correlation with histopathology was significant (P Value=<0.01 & Chi square value 40.7). Conclusion: The IAC Yokohama system is an excellent system for accurately diagnosing breast fine needle aspirate. Keywords: Histopathology, International Academy of Cytology Yokohama System, Fine­ Needle Aspiration Biopsy Cytopathology

Validation of the IAC Yokohama system for reporting breast fine-needle aspiration cytology categorization of breast lesions in Vindhya region population

Background: In 2016, International academy of cytology (IAC) has established a standardized approach for reporting breast fine-needle aspiration cytology (FNAC) by categorizing the lesions in five tier system from C1 to C5 to standardize reporting, which will enhance Breast fine-needle aspiration biopsy cytology performance, interpretation, and reporting. Aims and Objectives: The aim of the study was to categorize FNAC cases according to The IAC Yokohama System and evaluate the diagnostic ability of FNAC. Materials and Methods: The current prospective analytical study was carried out in the Department of Pathology, Shyam Shah Medical College, Rewa, Madhya Pradesh, for a period of 15 months from January 2021 to March 2022 (15 months). A total of 100 cases were included in the study based on inclusion criteria. The results were analyzed based on cytological reporting and P value calculated. Results: Among the 100 cases studied highest number of cases were from the age group of 21–30 years with 29% (n=29). The most common breast laterality affected was left with 69% of affected cases. The maximum number of cases, 69% (n=69) of the total, were found to be categorized under the category C2 (benign) which was followed by Category C5 (Malignant) seen in 13% (n=13). About 9% (n=9) of the total cases were categorized as suspicious of malignancy (C4). Atypical Lesion (C3) and Unsatisfactory Lesions (C1) were categorized in 5% (n=5) and 4% (n=4) of the total cases, respectively. Conclusion: FNAC is a minimally invasive, quick, and efficient pre-operative diagnostic tool that can also be used for postoperative breast lump follow-up to prevent recurrences. FNAC using IAC Yokohama system is a rapid and effective method for the primary categorization of palpable breast lumps and provides better clarity to the clinicians in the management of the patient and can reduce unnecessary surgeries.

Assessing the accuracy of the International Academy of Cytology Yokohama System for reporting breast fine needle aspiration biopsy cytology at a Vietnamese oncology centre.

Fine needle aspiration biopsy (FNAB), accompanied by classification systems for cytology, can offer a cheap and convenient option for the diagnosis of breast cancer in women with suspicious breast lumps. In this study, we aimed to assess the accuracy of the International Academy of Cytology (IAC) Yokohama system in a Vietnamese oncology centre. A retrospective cross-sectional study was conducted from November 2021 to April 2022 at Vietnam National Cancer Hospital. We included patients with full hospital records regarding breast lesions for which FNAB was indicated. A total of 803 patients' FNAB specimens were assessed according to the IAC Yokohama system. The basic characteristics were summarised using the appropriate summary measurements. The risk of malignancy (ROM) was calculated for each classification category. The median age was 42.7 years (range: 14-85). The mean size of the lesions was 17.9 mm (range: 4-123 mm). We had 215 histopathological reports. The most common benign and malignant diagnoses were fibroadenoma and invasive carcinoma, respectively. The ROM for categories II, III, IV, and V was calculated as 3.4%, 37.5%, 95%, and 99.2% respectively. The sensitivity, specificity, positive predictive value, and negative predictive value were 96.4%, 97.2%, 98.5%, and 93.2%, respectively. The IAC Yokohama system offers a good option with which to predict underlying breast pathology using a simple and cheap procedure. However, pathologists require continuous training to ensure accurate interpretation of the slides.

CYTOHISTOLOGICAL SPECTRUM OF BREAST LESIONS WITH RESPECT TO THE IAC YOKOHAMA SYSTEM FOR REPORTING BREAST FINE ASPIRATION CYTOLOGY-A TWO YEAR TERTIARY CARE CENTER EXPERIENCE

ntroduction: The new International Academy of Cytology (IAC) Yokohama System for Reporting Breast FNABC, supported by IAC and developed by an International “Breast Group”, was proposed to establish a comprehensive structured approach so as to standardize the diagnostic approach and improve reproducibility. To categorize the breast FNAB samples ac Aim: cording to this new system of Reporting and to assess various statistical parameters including Risk of Malignancy. Breast FNAB Materials And Method: specimens obtained in the cytology section of the Department of Pathology, AMCH were reported using the newly proposed IAC Yokohama System. The statistical parameters were calculated taking Histopathology as the Gold Standard. A total of 280 Cases with breast l Results And Observation esions were included, of which 16 of the Cases were categorized as Inadequate, 152 as benign, 5 as atypical, 16 as suspicious for malignancy and 91 as malignant. The ROM for each category was obtained. Considering Malignant and Suspicious for Malignancy cases as true positives, the Sensitivity was 95.05%, Specicity 98.46%, PPV 97.96%, NPV 96.24% and Diagnostic Accuracy 96.97%. The IAC Yokohama system for Reportin Conclusion g Breast FNAB cytology effectively straties breast lesions thus providing guidance to both cytopathologists and clinicians leading to better patient care

APPLICATION OF YOKOHAMA SYSTEM FOR BREAST FNAC WITH ASSESSMENT OF RISK OF MALIGNANCY.

ntroduction: This study is based on application of recently proposed International Academy of cytology (IAC) Yokohama system of Breast cytology. The main objective of the study was to categorise the Breast Fi Aim: ne Needle Aspiration Cytology (FNAC) samples according to this new system of reporting and to assess the Risk of malignancy (ROM) for each category as well as the diagnostic yield of the Breast FNAC. Materials and Methods: Total of 191 FNAC cytology smears from July 2021 to June 2022 were obtained. Microscopy was done and classication was done according to newly proposed IAC Yokohama system of reporting. The ROM was obtained. The sensitivity, specicity, Predictive Value (PPV), Negative Predictive Value (NPV) and accuracy of Breast FNAC were calculated accordingly. The Breast FNAB samples were Results: distributed as follows: insufcient material 6.29%, benign 63.87 %, Atypical probably benign 3.14%, suspicious for malignancy 4.71% and malignant 21.98%. Of the 191 FNAC cases, 44 cases had histopathological correlation. The respective ROM for each category was 00% for category 1 (insufcient), 00% for category 2 (benign), 33.3% for category 3 (atypical), 100% for category 4 (suspicious for malignancy) and 100% for category 5 (Malignant). The sensitivity, specicity, positive predictive value, negative predictive value and diagnostic accuracy were respectively 100%, 92.3%, 89.47% 100% and 95.35% when malignant, suspicious of malignancy and atypical categories were considered positive. Categorisation of the Breast FNAC cytology according to IAC Yokohama syste Conclusion: m of reporting helps pathologist in the diagnostic clarity and guides clinician in the appropriate patient management. IAC Yokohama system of reporting breast cytopathology serves as a common language to pathologist and clinician.

Cytomorphological patterns of breast lesions among women with palpable breast lumps attending select teaching and referral hospitals in Kenya: a descriptive cross-sectional study.

breast lumps account for a greater number of lesions in women attending surgical clinics in the developing world. Breast cancer which mostly presents as a breast lump is the leading cancer in Kenya, with an incidence of 12.5%. The study aims to describe the patterns of breast lesions in women presenting with palpable breast lumps in two major referral hospitals in Kenya. seven hundred and sixty-eight study participants with palpable lumps underwent fine needle aspiration cytology (FNAC). Sociodemographic data were captured using structured questionnaires. The FNAC materials were evaluated using the International Academy of Cytology Yokohama System (IACYS) and the lesions were classified into five-tier categories. Frequencies and percentages were used to summarize qualitative variables. of 768 smears, 84.8% (n=651) were adequate for evaluation while 15.2% (n=117) were inadequate. Neoplastic lesions comprised 84.5% (n=550) and non-neoplastic 15.5% (n=101). Benign lesions accounted for 83.6% of the lesions followed by breast carcinoma (10.4%). Ductal carcinoma comprised 98.5% of cancerous lesions. The age group most affected with ductal carcinoma and suspicious lesions was 20-34 years (37.3% and 55.6% respectively). Fibroadenoma formed the bulk of the benign lesions identified (44.1%). Suspicious of malignancy was 4.1% (n=27). The age group with the most lesions (47.5%) was 20-34 years. a wide spectrum of breast lesions was established. Such include inflammatory, atypical, benign, suspicious of malignancy, and malignant lesions. Fibroadenoma was a common lesion diagnosed. The age group most affected by malignant lesions was 16-49 years, necessitating enhanced screening of women with breast lumps in our setups.

Application of International Academy of Cytology Yokohama System for Reporting Breast Fine Needle Aspiration Cytology- A Retrospective Study

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.

The role of the IAC Yokohama System for Reporting Breast Fine Needle Aspiration Biopsy and the ACR Breast Imaging-Reporting and Data System in the evaluation of breast lesions.

Stratification of breast lesions for appropriate management is achieved through an integration of clinical examination, imaging, and fine needle aspiration biopsy (FNAB). The current study aimed to evaluate the combined effectiveness of the widely used Breast Imaging-Reporting and Data System (BI-RADS) with the recently proposed International Academy of Cytology (IAC) Yokohama System for Reporting Breast Fine Needle Aspiration Biopsy Cytopathology. A retrospective analysis was done on all breast FNABs from 2016 through 2020. The cases were categorised according to the IAC Yokohama System. Histopathological correlation of the BI-RADS and IAC Yokohama System was performed. The rate of malignancy (ROM) for each category of the BI-RADS and IAC Yokohama System was calculated. The ROM values for categories I to V were 38%, 0.6%, 21.9%, 100%, and 97%, respectively. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of FNAB with category III assumed as malignant were 98.9%, 85%, 76.1%, 99.3%, and 89.5%, respectively. With category III assumed as benign, these indices were 90.8%, 98.9%, 97.5%, 95.7%, and 96.2%, respectively. The sensitivity, specificity, PPV, NPV and accuracy of BI-RADS were 91.5%, 81.9%, 72%, 95%, and 85.1%, respectively. FNAB is still an indispensable test in the evaluation of breast lesions. The utilisation of the IAC Yokohama reporting system for breast cytology in conjunction with ACR BI-RADS aids in better stratification of lesions.

The International Academy of Cytology standardized reporting of breast fine-needle aspiration biopsy cytology: A 2 year's retrospective study with application of categories and their assessment for risk of malignancy.

Objectives:Breast cancer is the most common cancer in women worldwide. The fine-needle aspiration biopsy (FNAB) may be used as the first-line pathological investigation for evaluation and early diagnosis of the breast lesion. The FNAB helps to differentiate malignant from benign lesions. In the present study, we categorized the breast FNAB cases according to the International Academy of Cytology Yokohama System (IACYS) for reporting breast FNAB cytology and to assess the risk of malignancy (ROM) for each category.Material and Methods:A retrospective data of breast lesions were retrieved from the archives of pathology department between January 2018 and December 2019. The study got approval from the Institutional Ethics Committee. Only 123 cases with cytology and histopathological correlation were included in this study. The cytological category was given according to IACYS for reporting breast FNAB cytology.Results:The FNAB results were include as insufficient material 3.25% (4/123), benign 46.34% (57/123), atypical 12.2% (15/123), suspicious for malignancy (SM) 4.88% (6/123), and malignant 33.33% (41/123). The ROM was 50%, 7.27%, 40.0%, 83.33%, and 97.5% for NS, benign, atypical, SM, and malignant, respectively.Conclusion:FNAB is an important tool in the diagnosis and management of breast lesions, especially in financial constrained developing countries like India with limited resources, where practice of core needle biopsy is limited. The 5-tier IACYS for reporting breast FNAB improves the reproducibility of cytology reports across the world and helps in triaging the breast lesion patients.

Risk Stratification of Breast Fine-Needle Aspiration Biopsy Specimens Performed without Radiologic Guidance by Application of the International Academy of Cytology Yokohama System for Reporting Breast Fine-Needle Aspiration Cytopathology

Background and Objective: The International Academy of Cytology (IAC) Yokohama system for reporting breast fine-needle aspiration biopsy (FNAB) cytopathology has been proposed to standardize breast FNAB reporting. The aim of this study was to categorize breast FNAB cases performed by palpation without radiological guidance according to the IAC system, establish the risk of malignancy (ROM) for the categories and assess the system’s utility, pitfalls, and implications in low-resource/financial constraint settings. Methods: A retrospective analysis of palpation-guided FNAB of breast lesions performed without radiological guidance between January 2016 and December 2019 was carried out and was correlated with follow-up biopsies wherever available. A total of 1,089 cases were recategorized using the IAC Yokohama system. Histopathology follow-up was available for 400 cases. The data were analysed for ROM, positive predictive value (PPV), and negative predictive value (NPV). Results and Discussion: Out of 1,089 cases, 4.3% (n = 47) cases were categorized as insufficient, 82% (n = 893) as benign, 2.8% (n = 31) as atypical, 2.7% (n = 29) as suspicious of malignancy, and 8.2% (n = 89) as malignant. Some 400 cases had a follow-up biopsy, based on which, the ROM for the categories were 33.3%, 0.4%, 37.5%, 96%, and 100%. The NPV for the benign category was 99.6%. The PPV of the malignant category was 100%, that of combined suspicious of malignancy and malignant categories was 99%, and of combined atypical, suspicious of malignancy, and malignant was 90.6%. Conclusion: The IAC Yokohama system is useful in standardizing the reporting of cytopathology of breast lesions. FNAB with radiological guidance is ideal but in cases of finance/resource constraints, FNAB by palpation alone is satisfactory if the test result is in the benign, suspicious of malignancy, or malignant categories, which constitute 91.5% of the cases in this study. A repeat ultrasound-guided FNAB and/or core needle biopsy should be recommended for cases in the insufficient/inadequate or atypical categories.

Fine-Needle Aspiration Biopsy Cytopathology of Breast Lesions Using the International Academy of Cytology Yokohama System and Rapid On-Site Evaluation: A Single-Institute Experience

Introduction: Breast cancer is rapidly emerging as the leading cause of cancer in Indian women. Robust cytopathology and histopathology services are required to tackle this growing burden. The use of rapid on-site evaluation (ROSE) and the International Academy of Cytology (IAC) Yokohama System for Reporting Breast Fine-Needle Aspiration Biopsy (FNAB) Cytopathology, which offers structured protocols, are expected to improve breast cytopathology reporting. Methods: We retrieved the cytopathology slides, categorized them by the IAC Yokohama System and histopathology data of all the patients who had been investigated for breast lesions from September 2016 to December 2018, and compared the cytopathology and histopathology. Risk of malignancy (ROM) and performance metrics, like sensitivity, specificity, predictive values, accuracy, and area under the curve were computed. Results: A total of 1,147 FNABs were evaluated, of which 442 (38.5%) underwent ROSE and 624 (54.4%) histopathology. Reported using IAC categories, our cohort recorded 4.9% inadequate, 65.3% benign, 7.8% atypical, 3.3% suspicious for malignancy, and 18.7% malignant lesions. The overall sensitivity and specificity for identifying in situ and malignant lesions were 99.1% and 99.3%, respectively, and were substantially improved by ROSE. ROSE improved the concordance between cytopathology and histopathology from 76.9% to 90.2%, by reducing inadequate (p < 0.001) cases. The ROM increased along a gradient from inadequate to malignant categories, with the gradient being sharpened by ROSE. The false negativity rate was 0.7% and false positivity rate 0%. Conclusion: Incorporating ROSE and the IAC Yokohama System for breast cytopathology reporting improves accurate diagnosis of breast lesions, prevents missed diagnoses, and provides reliable estimates of ROM. These protocols also aid in standardizing a reproducible system for monitoring and auditing of breast pathology services, identify areas that need strengthening, and improve training at pathology centers.

Accuracy of Breast Fine-Needle Aspiration Biopsy Using the International Academy of Cytology Yokohama System in Clinico-Radiologically Indeterminate Lesions: Initial Findings Demonstrating Value in Lesions of Low Suspicion of Malignancy

Background: Fine-needle aspiration biopsy (FNAB) in breast lesions offers accurate results in differentiating benign and malignant lesions. However, its role is unclear when core-needle biopsy (CNB) is available, the latter providing additional information regarding tumor grade, invasion, and hormone receptor status in malignant lesions. In benign breast lesions, especially in BIRADS category 4a and 4b, FNAB, and CNB provide similar pathological information, whereby FNAB may serve as a more rapid and cost-effective investigation. The study was planned to reevaluate the diagnostic accuracy of FNAB in BIRADS category 4a, 4b, and 4c lesions. Materials and Methods: FNAB and biopsy reports of all patients with breast lesions sent between September 1, 2018, and November 30, 2020, were collected and the International Academy of Cytology (IAC) Yokohama category and BIRADS score were recorded for each case. The rate of malignancy and the accuracy of FNAB in diagnosing malignancy were calculated for each BIRADS 4a, 4b, and 4c subgroup. Results: A total of 249 cases of BIRADS 4 lesions had corresponding cytology and histopathology diagnoses. FNAB showed high diagnostic accuracy in all BIRADS groups. A benign categorization was associated with a very low number of false-negative diagnoses, especially in BIRADS 4a lesions. Conclusion: The study reconfirms the excellent accuracy of breast FNAB using the IAC Yokohama system in diagnosing breast malignancies. Furthermore, BIRADS 4a lesions found to be belonging to the cytological benign category may be excluded from CRB and kept on clinical follow-up.

Prospective evaluation of accuracy of fine-needle aspiration biopsy for breast lesions using the International Academy of Cytology Yokohama System for reporting breast cytopathology.

Classification of breast lesions into different cytological groups can accurately be done using the International Academy of Cytology (IAC) Yokohama System for reporting breast cytopathology. Fine needle aspiration biopsy (FNAB) of breast lesions has been considered to be the primary investigation in detecting breast cancers, especially in low-cost settings. The main objective of this study was to prospectively re-confirm the diagnostic accuracy of breast FNAB using the IAC Yokohama system. Additionally, separate secondary subgroup analysis was done to confirm the accuracy of breast FNAB excluding lymph-node positive and lymphadenopathy positive tumors. A prospective study was done on patients undergoing biopsy of breast lesions between September 01, 2019 and November 30, 2020 (519 biopsies on 487 unique patients). Of these 519 histopathology biopsies, 505 had corresponding FNAB report of the same site. The FNAB was reported using the IAC Yokohama system and the most suitable category was allotted in every case. The rates of malignancy for each category and the accuracy of breast FNAB in diagnosing malignancy were calculated. Of the total 487 patients, 120 cases were benign on histology, while 367 were malignant. The rates of malignancy in benign, atypical, suspicious and malignant categories were 5%, 25%, 71%, and 99.7%, respectively. The diagnostic accuracy of atypical, suspicious and malignant categories was calculated as 90.1%, 95.2%, and 93.3%, respectively. The high diagnostic accuracy for each BIRADS category suggest excellent accuracy for Breast FNAB using the IAC Yokohama system.

Implementation of the International Academy of Cytology Yokohama standardized reporting for breast cytopathology: An 8-year retrospective study.

The International Academy of Cytology (IAC) Yokohama reporting system was recently proposed to serve as a standardized diagnostic platform for the cytological interpretation of breast fine needle aspiration biopsy (FNAB). Five cytological categories were suggested, linked to a certain risk of malignancy (ROM). The aim of this study was to assess the potency of this newly proposed reporting guideline, with a review of literatures. This is a retrospective study over 8-year duration in which all the breast FNABs performed in our institution were recategorized in accordance to the IAC Yokohama reporting system. Kappa coefficient was used to evaluate the agreement between the proposed cytological category and corresponding histological diagnosis, with the level of significance set at 5%. Cyto-histopathological correlation and its diagnostic performance were also assessed. A total of 1136 breast FNABs were analyzed, including 31 repeat FNABs. Of these, 521 (47.1%) cases had matched histopathological results. Respective ROM for each category was: "insufficient" 13.6%, "benign" 0.4%, "atypical" 25.0%, "suspicious" 85.7%, and "malignant" 100%. There was substantial agreement (κ=0.757) between cytology and histopathological results. Our data revealed a high-diagnostic specificity, sensitivity, positive and negative predictive value of 99.3% (95% CI: 97.6%-99.9%), 94.2% (95% CI: 87.9%-97.9%), 98.0% (95% CI: 92.5%-99.5%), 98.0% (95% CI: 96.1%-99.1%) respectively when both the "suspicious" and "malignant" cases were considered as positive tests, with area under the curve of 0.993. The IAC Yokohama system is a reliable, evidence-based, and standardized reporting system that helps to facilitate communication among cytopathologists, radiologists, and surgeons toward individualized patient management.

Demystifying Breast FNAC’s Based on the International Academy of Cytology, Yokohama Breast Cytopathology System- A Retrospective Study

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.