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The International Academy of Cytology Yokohama System for Reporting Breast Fine Needle Aspiration Biopsy Cytopathology: Introduction and Overview

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The International Academy of Cytology Yokohama System for Reporting Breast Fine Needle Aspiration Biopsy Cytopathology

Abstract

The International Academy of Cytology (IAC) Yokohama System for Reporting Breast Fine Needle Aspiration Biopsy (FNAB) Cytology reporting system is an initiative of the IAC that seeks to provide a comprehensive, standardized approach to breast FNAB reporting to facilitate reproducible cytopathology reporting and to establish best practice guidelines. The system is evidence-based, supports a structured reporting format and will aid in maximizing the usefulness of the FNAB technique and optimizing communication with the clinical team and the patient.

The use of five categories was chosen to maintain a high negative predictive value of a benign diagnosis and a high positive predictive value of a malignant diagnosis. The categories are Insufficient/Inadequate, Benign, Atypical, Suspicious of Malignancy and Malignant and stratify breast FNAB cytology by the risk of malignancy.

The role of FNAB and the technique of performing FNAB and making direct smears are presented.

The Atlas outlines the definitions for each of the categories and provides key cytological diagnostic criteria, differential diagnoses and photomicrographs for the range of specific diagnoses for each category. The Atlas addresses in detail the problem areas of atypical and suspicious of malignancy, in particular the interpretation of in situ and borderline lesions. A management chapter is included to assist in determining management for each category in a spectrum of clinical scenarios and with a range of medical resources.

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References

  1. Ciatto S, Cariaggi P, Bulgaresi P, Confortini M, Bonardi R. Fine needle aspiration cytology of the breast: review of 9533 consecutive cases. Breast. 1993;2:87–90.

    Article  Google Scholar 

  2. Boerner S, Fornage BD, Singletary E, Sneige N. Ultrasound-guided fine-needle aspiration (FNA) of nonpalpable breast lesions: a review of 1885 FNA cases using the National Cancer Institute-supported recommendations on the uniform approach to breast FNA. Cancer. 1999;87(1):19–24.

    Article  CAS  PubMed  Google Scholar 

  3. Bulgaresi P, Cariaggi P, Ciatto S, Houssami N. Positive predictive value of breast FNAC in combination with clinical and imaging findings: a series of 2334 subjects with abnormal cytology. Breast Cancer Res Treat. 2006;97:319–21.

    Article  CAS  PubMed  Google Scholar 

  4. Orell S, Sterrett G. Ch 7. Breast fine needle aspiration cytology. 5th ed. Edinburgh: Churchill Livingstone; 2012.

    Google Scholar 

  5. Tse G, Tan PH, Schmitt F. Fine needle aspiration cytology of the breast. Berlin: Springer; 2013.

    Book  Google Scholar 

  6. Ducatman BS, Wang HH. Breast. In: Cibas E, Ducataman B, editors. Ch 9 in Cytology: Principles and Clinical Correlates. 4th ed. Philadelphia: Elsevier/Saunders; 2014.

    Google Scholar 

  7. Field AS. Chapter 5 Breast. In: Field AS, Zarka MR, editors. Practical Cytopathology: Pattern Recognition Diagnostic Approach. Saint Louis: Elsevier; 2016.

    Google Scholar 

  8. Chaiwun B, Settakorn J, Ya-In C, Wisedmongkol W, Rangdaeng S, Thorner P. Effectiveness of fine-needle aspiration cytology of breast: analysis of 2,375 cases from northern Thailand. Diagn Cytopathol. 2002;26(3):201–5.

    Article  PubMed  Google Scholar 

  9. Ukah CO, Oluwasola OA. The clinical effectiveness of FNAB in patients with palpable breast lesions seen at the University College Hospital, Ibadan, Nigeria: a ten year retrospective study. J Cytol. 2011;28:111–3.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Ly A, Ono JC, Hughes KS, Pitman MB, Balassanian R. FNAB of palpable breast masses: patterns of clinical use and patient experience. J Natl Compr Cancer Netw. 2016;14:527–36.

    Article  Google Scholar 

  11. Dong J, Ly A, Arpin R, et al. Breast fine needle aspiration continues to be relevant in a large academic medical center: experience from Massachusetts General Hospital. Breast Cancer Res Treat. 2016;158:297–305.

    Article  PubMed  Google Scholar 

  12. Farras Roca JA, Tardivon A, Thibault F, et al. Diagnostic performance of ultrasound-guided fine-needle aspiration of nonpalpable breast lesions in a multidisciplinary setting: the Institut Curie’s experience. Am J Clin Pathol. 2017;147:571–9.

    Article  PubMed  Google Scholar 

  13. Hoda R, Brachtel E. IAC Yokohama system for reporting breast FNAB cytology: a review of predictive values and risks of malignancy. Acta Cytol. 2019;63:292–301.

    Article  PubMed  Google Scholar 

  14. Wong S, Rickard M, Earls P, Arnold L, Bako B, Field AS. The IAC Yokohama system for reporting breast FNAB cytology: a single institutional retrospective study of the application of the system and the impact of ROSE. Acta Cytol. 2019;63:280–91.

    Article  PubMed  Google Scholar 

  15. Montezuma D, Malheiros D, Schmitt F. Breast FNAB cytology using the newly proposed IAC Yokohama system for reporting breast cytopathology: the experience of a single institution. Acta Cytol. 2019;63:274–9.

    Google Scholar 

  16. Nguansangiam S, Jesdapatarakul S, Tangjitgamol S. Accuracy of fine needle aspiration cytology from breast masses in Thailand. Asian Pac J Cancer Prev. 2009;10(4):623–6.

    PubMed  Google Scholar 

  17. Abdel-Hadi M, Abdel-Hamid GF, Abdel-Razek N, Fawzy RK. Should fine-needle aspiration cytology be the first choice diagnostic modality for assessment of all nonpalpable breast lesions? The experience of a breast cancer screening center in Alexandria Egypt. Diagn Cytopathol. 2010;38(12):880–9.

    Article  PubMed  Google Scholar 

  18. Aker F, Gumrukcu G, Onomay BC, et al. Accuracy of fine-needle aspiration cytology in the diagnosis of breast cancer a single-center retrospective study from Turkey with cytohistological correlation in 733 cases. Diagn Cytopathol. 2015;43(12):978–86.

    Article  PubMed  Google Scholar 

  19. Daramola AO, Odubanjo MO, Obiajulu FJ, Ikeri NZ, Banjo AA. Correlation between fine-needle aspiration cytology and histology for palpable breast masses in a Nigerian tertiary health institution. Int J Breast Cancer. 2015;2015:742573.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Nkonge KM, Rogena EA, Walong EO, Nkonge DK. Cytological evaluation of breast lesions in symptomatic patients presenting to Kenyatta National Hospital, Kenya: a retrospective study. BMC Womens Health. 2015;15:118.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Miskovic J, Zoric A, Radic Miskovic H, Soljic V. Diagnostic value of fine needle aspiration cytology for breast tumors. Acta Clin Croat. 2016;55(4):625–8.

    Article  PubMed  Google Scholar 

  22. Ibikunle DE, Omotayo JA, Ariyibi OO. Fine needle aspiration cytology of breast lumps with histopathologic correlation in Owo, Ondo State, Nigeria: a five-year review. Ghana Med J. 2017;51(1):1–5.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Field AS, Vielh P, Schmitt F. IAC standardized reporting of breast FNA biopsy cytology. Acta Cytol. 2017;61:3–6.

    Article  PubMed  Google Scholar 

  24. Field AS, Raymond W, Rickard M, et al. The International Academy of Cytology Yokohama system for reporting breast fine needle aspiration biopsy cytology. Acta Cytol. 2019;63:257–73.

    Article  PubMed  Google Scholar 

  25. Brown LA, Coghill SB. Fine needle aspiration cytology of the breast: factors affecting sensitivity. Cytopathology. 1991;2:67–74.

    Article  CAS  PubMed  Google Scholar 

  26. Howell LP, Gandour-Edwards R, Folkins K, Davis R, Yasmeen S, Afify A. Adequacy evaluation of fine-needle aspiration biopsy in the breast health clinic setting. Cancer Cytopathol. 2004;102:295–301.

    Article  Google Scholar 

  27. Ljung BM, Drejet A, Chiampi N, et al. Diagnostic accuracy of FNAB is determined by physician training in sampling technique. Cancer Cytopathol. 2001;93:263–8.

    Article  CAS  Google Scholar 

  28. Delaloge S, Bonastre J, Borget I, et al. The challenge of rapid diagnosis in oncology: Diagnostic accuracy and cost analysis of a large-scale one-stop breast clinic. Eur J Cancer. 2016;66:131–7.

    Article  PubMed  Google Scholar 

  29. Masood S. Diagnostic terminology in FNAB of the breast. Cancer Cytopathol. 1999;87:1–4.

    Article  CAS  Google Scholar 

  30. Kocjan G, Feichter G, Hagmar B, et al. FNAC: a survey of current European practice. Cytopathology. 2006;17:219–26.

    Article  CAS  PubMed  Google Scholar 

  31. Field AS. Breast FNAB cytology: current problems and the IAC Yokohama standardized reporting system. Cancer Cytopathol. 2017;125:229–30.

    Article  PubMed  Google Scholar 

  32. Klijanienko J, Sauer T, Garred U, et al. Assessing invasive criteria in FNA from breast carcinoma diagnosed as DCIS or invasive carcinoma: can we identify an invasive component in addition to DCIS? Acta Cytol. 2006;50z:263–70.

    Google Scholar 

  33. Klijanienko JKS, Vielh P, Masood S. Stromal infiltration as a predictor of tumor invasion in breast fine-needle aspiration biopsy. Diagn Cytopathol. 2004;30(3):182–6.

    Article  PubMed  Google Scholar 

  34. Bonzanini M, Gilioli E, Brancato B, Cristofori A, Bricolo D, Natale N, et al. The cytopathology of ductal carcinoma in situ of the breast. A detailed analysis of fine needle aspiration cytology of 58 cases compared with 101 invasive ductal carcinomas. Cytopathology. 2001;12(2):107–19.

    Article  CAS  PubMed  Google Scholar 

  35. Sauer T, Young K, Thoresen SO. Fine needle aspiration cytology in the work-up of mammographic and ultrasonographic findings in breast cancer screening: an attempt at differentiating in situ and invasive carcinoma. Cytopathology. 2002;13(2):101–10.

    Article  PubMed  Google Scholar 

  36. Simsir A, Waisman J, Cangiarella J. Fibroadenomas with atypia: causes of under and overdiagnosis by aspiration biopsy. Diagn Cytopathol. 2001;25:278–84.

    Article  CAS  PubMed  Google Scholar 

  37. Field AS, Mak A. A prospective study of the diagnostic accuracy of cytological criteria in the FNAB diagnosis of breast papillomas. Diagn Cytopathol. 2007;35:465–75.

    Article  PubMed  Google Scholar 

  38. Silverman JF, Masood S, Ducatman BS, et al. Can FNA biopsy separate atypical hyperplasia, carcinoma in-situ, and invasive carcinoma of the breast? Cytomorphologic criteria and limitations in diagnosis. Diagn Cytopathol. 1993;24:630–5.

    Google Scholar 

  39. Bofin AM, Lydersen S, Hagmar BM. Cytological criteria for the diagnosis of intraductal hyperplasia, ductal carcinoma in situ, and invasive carcinoma of the breast. Diagn Cytopathol. 2004;31:207–15.

    Article  PubMed  Google Scholar 

  40. Yu S-N, Li J, Wong S-I, et al. Atypical aspirates of the breast: a dilemma in current cytology practice. J Clin Pathol. 2017;70:1024–32.

    Article  CAS  PubMed  Google Scholar 

  41. Lieske B, Ravichandran D, Wright D. Role of fine-needle aspiration cytology and core biopsy in the preoperative diagnosis of screen-detected breast carcinoma. Br J Cancer. 2006;95:62–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Wang M, He X, Chang Y, Sun G, Thabane L. A sensitivity and specificity comparison of fine needle aspiration cytology and core needle biopsy in evaluation of suspicious breast lesions: A systematic review and meta-analysis. Breast. 2017;31:157–66.

    Article  PubMed  Google Scholar 

  43. Kojcan G, Bourgain C, Fassina A, et al. The role of FNAC in diagnosis and clinical management: a survey of current practice. Cytopathology. 2008;19:271–8.

    Article  Google Scholar 

  44. Gibbons CE, Quinn CM, Gibbons D. Fine needle aspiration biopsy management of the axilla in primary breast carcinoma. Acta Cytol. 2019;63:314–8.

    Article  PubMed  Google Scholar 

  45. Boughey JC, Moriarty JP, Degnim AC, et al. Cost modelling of preoperative axillary ultrasound and FNA to guide surgery for invasive breast cancer. Ann Surg Oncol. 2010;17:953–8.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Masood S, Rosa M, Kraemer DF, Smotherman MS, Mohammadi A. Comparative cost-effectiveness of FNAB versus image-guided CNB, and open surgical biopsy in the evaluation of breast cancer in the era of the Affordable Care Act: a changing landscape. Diagn Cytopathol. 2015;43:605–12.

    Article  PubMed  Google Scholar 

  47. van Zante A, Ljung BM. Fine-needle aspiration versus core needle biopsy: Reconsidering the evidence of superiority. Cancer Cytopathol. 2016;24:853–6.

    Article  Google Scholar 

  48. Uematsu T, Kashimi M. Risk of needle tract seeding of breast cancer: cytological results derived from core wash material. Breast Cancer Res Treat. 2008;110:51–5.

    Article  PubMed  Google Scholar 

  49. Sennerstam RB, Franzen BSH, Wiksell HOT, Auer GU. Core needle biopsy of breast cancer is associated with a higher rate of distant metastases 5 to 15 years after diagnosis than FNAB. Cancer Cytopathol. 2017;125:748–56.

    Article  CAS  PubMed  Google Scholar 

  50. Masood S, Vass L, Ibarra JA Jr. Breast pathology guideline implementation in low- and middle income countries. Cancer. 2008;113:2297–304.

    Article  PubMed  Google Scholar 

  51. Anderson BO. FNAB for breast cancer diagnosis: one size does not fit all. J Natl Compr Cancer Netw. 2016;14:599–600.

    Article  Google Scholar 

  52. Field AS. Cytopathology in low medical infrastructure countries: how to integrate to capacitate health care, in clinics in laboratory medicine. In: Global health and pathology. Philadelphia: Elsevier; 2018.

    Google Scholar 

  53. Vohra P, Buelow B, Chen YY, et al. Estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 expression in breast cancer FNA cell blocks and paired histologic specimens: a large retrospective study. Cancer Cytopathol. 2016;124:828–35.

    Article  CAS  PubMed  Google Scholar 

  54. Beca F, Schmitt FC. Ancillary tests in breast cytology; a practical review. Acta Cytol. 2019;63:302–13.

    Article  PubMed  Google Scholar 

  55. Field AS, Geddie WR. Ch 1 and 2, in Lymph node and spleen Cytohistology. Cambridge: Cambridge University Press; 2014.

    Google Scholar 

  56. Ljung BM. https://www.youtube.com/watch?v=nWhB6WhX9AQ&list=PLaWBzZZDQvpecETKjD7_gupwB34tlcOWZ. Last accessed Mar 2019.

  57. Gerhard R, Schmitt FC. Liquid-based cytology in fine-needle aspiration of breast lesions: a review. Acta Cytol. 2014;58:533–42.

    CAS  PubMed  Google Scholar 

  58. Istvanic SI, Fischer AH, Banner BF, et al. Cell blocks of breast FNAB frequently allow diagnosis of invasion or histological classification of proliferative changes. Diagn Cytopathol. 2007 May;35(5):263–9.

    Article  PubMed  Google Scholar 

  59. Williams SL, Birdsong GG, Cohen C, Siddiqui MT. Immunohistochemical detection of estrogen and progesterone receptor and HER2 expression in breast carcinomas: comparison of cell block and tissue block preparations. Int J Clin Exp Pathol. 2009;2(5):476–80.

    CAS  PubMed  PubMed Central  Google Scholar 

  60. Ferguson J, Chamberlain P, Cramer HM, Wu HH. ER, PR, and Her2 immunocytochemistry on cell-transferred cytologic smears of primary and metastatic breast carcinomas: a comparison study with formalin-fixed cell blocks and surgical biopsies. Diagn Cytopathol. 2013;41(7):575–81.

    Article  PubMed  Google Scholar 

  61. Ellis DW, Srigley J. Does standardised structured reporting contribute to quality in diagnostic pathology? The importance of evidence-based data sets. Virchows Arch. 2016;468:51–9.

    Article  CAS  PubMed  Google Scholar 

  62. Royal College of Australasia. Structured pathology reporting of cancer. https://www.rcpa.edu.au/Health-Care. Accessed Feb 2019.

  63. International Confederation Cancer Reporting (ICCR). https://www.iccr-cancer.org. Accessed Feb 2019.

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Field, A.S. et al. (2020). The International Academy of Cytology Yokohama System for Reporting Breast Fine Needle Aspiration Biopsy Cytopathology: Introduction and Overview. In: Field, A.S., Raymond, W.A., Schmitt, F. (eds) The International Academy of Cytology Yokohama System for Reporting Breast Fine Needle Aspiration Biopsy Cytopathology. Springer, Cham. https://doi.org/10.1007/978-3-030-26883-1_1

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  • DOI: https://doi.org/10.1007/978-3-030-26883-1_1

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