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(searched for: doi:10.4103/0973-1482.199452)
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Jitendra Singh Nigam, , Shreekant Bharti, Surabhi, Ruchi Sinha, Punam Prasad Bhadani
Published: 3 November 2021
Journal: Cytojournal
Abstract:
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.
Ersilio Trapanese, Giulio Tarro
Published: 18 October 2021
Translational Medicine Communications, Volume 6, pp 1-10; https://doi.org/10.1186/s41231-021-00105-1

Abstract:
Background Today, breast cancer is one of the most aggressive cancers in women and new cases continue to increase worldwide. The incidence of this tumor is kept under control especially with surgery. In order to reduce mortality we need to detect this life threatening disease at an earlier stage. For two years, we have conducted a study for the identification and characterization of suspicious breast lesions using a new diagnostic technique applied to ultrasonography and mammography called “PhiΦBreast.” Methods Identification and characterization of category C4-C5 lesions of the breast with high Predictive Positive PPV value, with a new innovative method called “PhiΦBreast” using the Golden Ratio (Phi, or Φ 1.618...) Fibonacci sequence and a Predictive Algorithm, applied to the ultrasonography and mammography with subsequent deepening with cytological examination using fine needle aspiration (FNAC), according to evaluation criteria of the Breast Imaging Report Data System (BI-RADS) and the American College of Radiology (ACR). Usefulness of this research and the use of this new diagnostic tecnique is to detect the breast cancer in early stage. In addition to develop a classification model of the histological type identified in the section areas and the percentage of probability in relation between the golden spiral and Fibonacci sequence. This amazing intuition and research has given contribution to the new Theory of Spiral Cancer. Results With the use of Golden Ratio and Fibonacci sequence, applied to ultrasonography and mammography, we have experimented and developed a diagnostic map with characteristics of high probability of identifying suspicious lesions at an early stage. We examined 987 women, 55 lesions detected with PhiΦBreast pattern were classified according to BI-RADS descriptors for US-imaging, including morphologic features that had a high predictive value for the malignancy (p <0.001). This innovative diagnostic technique has shown a sensitivity of 95%, a specificity of 97%, a positive predictive value of 97%, and negative predictive value of 96%. The discriminating capacity of PhiΦBreast was significantly better than normal ultrasonography (P < 0,05). Furthermore with a predictive algorithm associated with malignant cytology after FNAC, we have classified different types of potentially life threatening cancers for patients. Conclusion PhiΦBreast could be an important new model diagnostic technique to be applied ultrasound and mammography for detection of malignant lesions of category C4-C5. In diagnostic imaging beyond the identification of a lesion and classification according to the BI-RADS category and the evaluation criteria of the ACR is fundamental to recognize predictively the characteristics of a potentially aggressive tumor. Everything mentioned above, reinforces the concept that the early diagnosis is essential because it allows to remove small tumors and therefore capable of producing more limited metastases than the potential of the most voluminous neoplasm. This way, we could plan an effective cure for the patient. This new model (PhiΦBreast) could represent the cornerstone as an important contribution for early diagnosis of breast cancer.
Neha Agrawal, Kanchan Kothari, , Prashant Sood, Mona Agnihotri, Vyoma Shah
Published: 27 August 2021
Journal: Acta Cytologica
Acta Cytologica, Volume 65, pp 463-477; https://doi.org/10.1159/000518375

Abstract:
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.
, Gang Wang, Malcolm Hayes
Published: 1 November 2019
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