IAC_YOKOHAMA_REPORTING_OF_BREAST_CA_lyst4347

Article Information

• Title: The International Academy of Cytology Yokohama System for Reporting Breast Fine-Needle Aspiration Biopsy Cytopathology

• Authors: Andrew S. Field, Wendy A. Raymond, Mary Rickard, Lauren Arnold, Elena F. Brachelet, Benjaporn Chaiwun, Lan Cheng, Luigi Di Bonito, Daniel F.I. Kurtyczi, Andrew H.S. Lee, Elgene Lim, Britt-Marie Ljung, Pamela Michelow, Robert Y. Osamura, Maurizio Pinamonti, Torill Sauer, Davendra Segaras, Gary Tset, Philippe Vielh, Phek Y. Chong, Fernando Schmitt

• Published: Acta Cytologica, 2019;63:257–273

• DOI: 10.1159/000499509

Abstract

• The International Academy of Cytology (IAC) has established a standardized reporting system for breast fine-needle aspiration biopsy (FNAB) cytology.

• The system was developed by a collaborative group of cytopathologists and clinicians experienced in breast diagnostics.

• The project started with a meeting at the 2016 International Congress of Cytology in Yokohama.

• Key Features of the IAC Yokohama System:

  • Five reporting categories: Insufficient/Inadequate, Benign, Atypical, Suspicious of Malignancy, Malignant.

  • Each category includes a clear term, definition, Risk Of Malignancy (ROM), and management algorithm.

  • Emphasizes the importance of high-quality FNAB procedures and the role of trained cytopathologists.

  • Current FNAB practices and indicators have been reviewed and adapted to optimize patient management.

Introduction

• The IAC System for Reporting Breast FNAB Cytology is aimed at standardizing reporting, improving practitioner communication, and linking cytology findings with patient management.

• The development followed changes in the role of FNAB with increasing reliance on core needle biopsy (CNB) and was informed by literature and expert feedback.

• FNAB is noted for its rapid, accurate, cost-effective performance with minimal complications in diagnosing breast lesions.

Key Components of the IAC Yokohama System

• Categories for Reporting FNAB:

  • Insufficient/Inadequate: Smears too poorly cellular or fixed for a diagnosis.

  • Benign: Clear benign features; further biopsy usually unnecessary.

  • Atypical: Features seen in benign processes but with some that are uncommon; indicates a potential for malignancy.

  • Suspicious of Malignancy: Some malignant features but not definitive; indicates further examination is required.

  • Malignant: Clear signs of malignancy, where further management is necessary.

Performance Indicators

• Evaluates measurements for FNAB, including specificity, sensitivity, PPV, NPV, and ROM derived from literature.

• Recent findings indicate specific ROM rates across categories for insufficient (2.6–4.8%), benign (1.4–2.3%), atypical (13–15.7%), suspicious (84.6–97.1%), and malignant (99.0–100%).

Management Recommendations

• Emphasizes a comprehensive approach that includes clinical, imaging, and cytological findings in the management of breast lesions.

• Recommends FNAB results be used to guide management decisions based on individual patient scenarios.

• Proposes further study and refinement based on ongoing data collection and analysis.

Technical Aspects of FNAB

• Emphasizes the need for proper training in FNAB technique and processing of smears, with standardized reporting enhancing communication between cytopathologists and clinicians.

• Discusses the technical procedures involved in FNAB including the importance of sufficient cellularity and appropriate categorization of results.

Conclusion

• The IAC Yokohama System will stimulate ongoing discussion and research, aiming for improved patient outcomes in breast diagnostic practices.

• By standardizing reporting, the system hopes to bridge gaps between cytopathologists, clinicians, and imaging specialists for better management of breast lesions.

References

• Cites a range of studies and documents informing the guidelines and practices discussed throughout the paper.