Suspicious Rates Research Articles

Is prostatic adenocarcinoma detectable by urine cytology-A multicenter retrospective review.

Urine cytology is robust for the diagnosis of urothelial lesions, but data on the detection rates of prostatic adenocarcinoma in urine cytology is limited. In this study, a multicenter review was performed to define the clinical role of urine cytology in diagnosis of prostatic adenocarcinoma. Cytologic diagnoses of lower tract urine cytology specimens with histology-proven prostatic adenocarcinoma from three institutions, from a period of over two decades, were reviewed. Clinicopathological parameters-tumor grade, stage, histologic features, and preanalytical factors-prostate-specific antigen (PSA) level and lesion size, were retrieved and compared with cytologic diagnoses. In total, 2115 urine cytology specimens from 1119 patients were retrieved. The atypia (or above/C3+) and suspicious (or above/C4+) rates were 19.48% and 3.36%. Bilobar and extracapsular involvement, lymphovascular invasion, Gleason score, and International Society of Urological Pathology grade were associated with a positive urine diagnosis (p < 0.05). The atypia (C3+) and suspicious (C4+) rates of urine cytology in patients with a PSA level of ≤4.0 ng/mL was paradoxically higher (p < 0.01), but PSA levels correlated positively with urine diagnosis at higher cutoffs (>10, >20, >50, >100 ng/mL). All these factors remained significant on multivariate analysis (p < 0.05), including a negative correlation with low-PSA (≤4.0 ng/mL, p = 0.001) and positive correlation with high-PSA (>20 ng/mL, p = 0.020). Lesion size and multifocality were not associated with urine cytology diagnosis (p > 0.05). Urine cytology showed low sensitivity in detection of prostatic adenocarcinoma. Detection rates were largely positively correlated with PSA levels but not for lesion size nor multifocality, limiting its clinical utility.

Global impact of the COVID-19 pandemic on cytopathology practice: Results from an international survey of laboratories in 23 countries.

To the authors' knowledge, the impact of the coronavirus disease 2019 (COVID-19) pandemic on cytopathology practices worldwide has not been investigated formally. In the current study, data from 41 respondents from 23 countries were reported. Data regarding the activity of each cytopathology laboratory during 4 weeks of COVID-19 lockdown were collected and compared with those obtained during the corresponding period in 2019. The overall number and percentage of exfoliative and fine-needle aspiration cytology samples from each anatomic site were recorded. Differences in the malignancy and suspicious rates between the 2 periods were analyzed using a meta-analytical approach. Overall, the sample volume was lower compared with 2019 (104,319 samples vs 190,225 samples), with an average volume reduction of 45.3% (range, 0.1%-98.0%). The percentage of samples from the cervicovaginal tract, thyroid, and anorectal region was significantly reduced (P < .05). Conversely, the percentage of samples from the urinary tract, serous cavities, breast, lymph nodes, respiratory tract, salivary glands, central nervous system, gastrointestinal tract, pancreas, liver, and biliary tract increased (P < .05). An overall increase of 5.56% (95% CI, 3.77%-7.35%) in the malignancy rate in nongynecological samples during the COVID-19 pandemic was observed. When the suspicious category was included, the overall increase was 6.95% (95% CI, 4.63%-9.27%). The COVID-19 pandemic resulted in a drastic reduction in the total number of cytology specimens regardless of anatomic site or specimen type. The rate of malignancy increased, reflecting the prioritization of patients with cancer who were considered to be at high risk. Prospective monitoring of the effect of delays in access to health services during the lockdown period is warranted.

Validity of fine needle aspiration cytology of the palpable breast lesions: A teaching hospital experience

Background and Objective: Fine needle aspiration cytology has assumed a great importance in the pre-operative diagnosis of palpable breast lesions in several hospital and clinical settings worldwide. This study aims to audit its diagnostic utility and validity in a tertiary hospital, and to review some of the diagnostic pitfalls in interpretation of breast cytology. Materials and Methods: The study comprised of breast cytology reports and their subsequent tissue biopsy diagnoses recorded over a 5-year period from January 2008 to December 2012. Results: A total of 1162 breast cytology reports were made over the review period out of which 200 had histological confirmation. Out of the 200 cases, 109 (54.5%) were benign (C2), 20 (10.0%) cases were suspicious probably benign (C3), 27 (13.5%) cases were suspicious probably malignant (C4) and 44 (22.0%) were malignant (C5). The cytology reports were correlated with subsequent histological diagnoses. Of the 109 benign C2 reports, 99 were confirmed on tissue histology as truly benign (true negatives) and the remaining 10 cases were malignant (false negatives). Forty-three of the 44 malignant (C5) cytology reports initially made were confirmed as malignant on tissue histology (true positives). The remaining malignant (C5) cytology case was, however, revealed to be benign (false positive). The overall suspicious rate (C3 and C4) was 23.5%. The absolute sensitivity was 81.0%, specificity was 99.0%, positive predictive value (PPV) (C5) of 97.7%, negative predictive value (NPV) (C2) of 90.8%. The false positive rate (FPR), false negative rate (FNR) and suspicious rates (SR) were 1.2%, 12.0% and 23.5%, respectively. Conclusion: Fine needle aspiration cytology of the breast has recorded high absolute sensitivity and specificity in our centre with a marginally high false positive rate. It has thus continued to have relevance as an important pre-operative diagnostic tool in the management of palpable breast lesions in our hospital.

Evaluation of the clinical efficacy of minimally invasive procedures for breast cancer screening at a teaching hospital

AimsTo assess the clinical efficacy of diagnostic procedures for breast cancer at a teaching hospital using internal auditing tools and quality control measures.MethodsA retrospective assessment of 500 patients who underwent...

Abstract P6-02-02: Evaluation of the Clinical Efficacy of Minimally Invasive Procedures for Breast Cancer Screening at a Teaching Hospital

Abstract Objective: To assess the clinical accuracy of diagnostic procedures for breast cancer at a teaching hospital using internal auditing tools and quality control measures. Study Design: Retrospective assessment of 500 patients who underwent core needle biopsy (wide-bore needle biopsy - WBN) of palpable or non-palpable breast nodes and also were submitted to at least one cytologic examination [fine needle aspiration cytology (FNA) and/or imprint of a WBN specimen]. For statistical assessment, we utilized the auditing tool and quality control proposed by the National Health Service — Breast Screening Program (NHSBSP). Results: For FNA, specificity full (SPEC), positive predictive value (PPV), inadequate rates and suspicious rates were satisfactory while absolute sensitivity (AS), complete sensitivity (CS), false-negatives (FNs) and false-positives (FPs) were unsatisfactory. For imprint, AS, CS, inadequate rate from cancers and suspicious rate were satisfactory, and the remaining indicators were unsatisfactory. WBN displayed the best performance with AS, CS, FN, suspicious rate, SPEC and PPV, showing satisfactory results and only one unsatisfactory result (FP). Comparison of quality control measures of fine-needle aspiration (n=395), imprint (n=182) and core-needle biopsy (n=500) performed at the UNIFESP-EPM Breast Clinic from January 2002 to April 2007 with the Min — minimuml; Unif — Unifesp-EPM; PPV — Positive predictive value, NA — not applicable Conclusion: Based on an overall analysis, WBN displayed the highest clinical efficacy compared with FNA and imprint and demonstrated adequate safety for confirming the appropriate diagnosis and management of patients, ensuring the efficacy of the service. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P6-02-02.

Diagnosing breast lesions by fine needle aspiration cytology or core biopsy: which is better?

Fine needle aspiration cytology (FNAC) and core needle biopsy (CNB) are widely used in diagnosing breast lesions, with both achieving high sensitivity and specificity. Whether FNAC or CNB is better remains highly controversial. In this review, the advantages and disadvantages of each of these methods are discussed, especially in relation to specific problematic groups of breast lesions. In general, CNB has a slight advantage with lower inadequate and suspicious rates, allowing easier grade assessment and ancillary testings (hormome receptors, HER2) in cases of cancers. FNAC cannot reliably predict invasion in a malignant aspirate, whereas CNB, although useful in confirming invasion in carcinomas, has a much lower efficacy in predicting invasion when only in situ carcinoma is detected. The other problematic areas are papillary breast lesions and fibroepithelial lesions, notably phyllodes tumors. In papillary lesions, FNAC diagnosis is inaccurate, but with CNB, one can confidently diagnose papillary lesion, although there is still significant false positive and false negative rates, even with immunohistochemistry. For fibroepithelial lesions, using either FNAC or CNB to differentiate between a phyllodes tumor from fibroadenoma is also inaccurate. As management of breast diseases necessitates the triple approach (clinical, imaging and pathological), an awareness of the limitations of these very useful diagnostic modalities by all specialists is prudent, especially when dealing with these specific groups of breast lesions.

False positive endoscopic ultrasound fine needle aspiration cytology: incidence and risk factors

ObjectiveIt is broadly accepted that the false positive (FP) rate for endoscopic ultrasound fine needle aspiration (EUS FNA) is 0–1%. It was hypothesised that the FP and false suspicious (FS)...

The gold standard EUS FNA false positive and false suspicious rates: correlation with surgical pathology in the absence of neoadjuvant therapy (Mayo Clinic 1993-2007 experience)

Background: It is generally assumed that the false positive [FP] rate for EUS FNA is 0-1% and a positive interpretation is regarded as confirmation of malignancy. However, the FP rate for FNA obtained via other routes is reported to be 1-16% and even greater. We hypothesized that the FP and false suspicious [FS] rates for EUS FNA are greater than currently perceived and sought to determine the etiology of the false cytological interpretations.

Conversion to core biopsy in preoperative diagnosis of breast lesions: is it justified by results?

In recent years there has been increased use of core biopsy for the preoperative diagnosis of screen detected and symptomatic breast lesions. The aim of this study was to compare the quality assessment parameters for preoperative diagnosis by fine needle aspiration cytology (FNAC) before conversion to core biopsy with those for core biopsy after conversion in screening and symptomatic practice. Accuracy of typing and grading of tumours on core biopsy was assessed. Correlation of FNAC (C1-5) and core biopsy (B1-5) results (total of 1768 cases) with subsequent available resection histology was performed for 473 FNAC samples in 1997/98, 349 core biopsies in 1998/99 performed in symptomatic practice, for 561 FNAC samples in 1997/98, and 385 core biopsies in 1998/99 performed in screening. Quality assessment parameters were calculated using the methodology detailed in the National Health Service Breast Screening Programme guidelines for cytology practice. Increased absolute and complete specificity, lower inadequate rates, and lower suspicious rates were found for core biopsy compared with FNAC in both symptomatic and screening practice. Typing of tumours was attempted in 86.7% of core biopsies in symptomatic practice and was accurate in 93.6% (132 of 141 where type was stated). Grading of tumours was attempted in 63.5% of invasive carcinomas, with the provisional grade on core biopsy being confirmed on later histology in 75% of grade 1 cases, in 70% of grade 2 cases, and in 86% of grade 3 cases. No case provisionally graded as 1 was subsequently found to be grade 3 and no provisionally grade 3 case was found to be grade 1. Conversion to core biopsy for the preoperative diagnosis of breast lesions increases specificity and reduces inadequate and suspicious rates. Grading and typing of tumours and assessment of oestrogen receptor status by immunocytochemistry is also possible in core biopsy, thereby increasing diagnostic information available when considering treatment options.

Diagnostic Reliability of Combined Approach of Physical Examination, Mammography and Fine Needle Aspiration Biopsy in Patients with Breast Cancer

Breast cancer is a common malignancy in females. For that reason the disease has to be suspected when one encounters a solid mass in the breast. Until recently in order to find out the actual nature of the lump both excisional biopsy and histopathologic examination were thought to be essential. Nowadays fine-needle aspiration biopsy (FNAB) is performed to evaluate the solid mass in the breast and by using this technique individual characteristics of each cell can lead to diagnosis. But it is reported that erroneous diagnosis is more common with FNAB than with excisional biopsy and histopathologic examination. Despite the recent advances in diagnostic techniques physical examination is still the first step in breast cancer diagnosis and it is the most widely used method. Mammography and FNAB should follow. However the accuracy rate of mammography alone is especially low for the evaluation of small masses. Therefore FNAB has become of use as an important adjunctive diagnostic procedure and it is used along with physical and mammographic examinations. Some authors report that the rate of correct diagnosis rises sometimes up to 100% when these three methods are applied together. The aim of the present study is to detect the diagnostic reliability of a combined approach with physical examination mammography and FNAB in patients with breast cancer. (excerpt)